Individual
TIAGO FONSECA LIZARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10 DORRANCE STREET STE 700, PROVIDENCE, RI 02903
(877) 418-2978
Mailing address
350 FAIRWAY DR, DEERFIELD BEACH, FL 33441-1834
(877) 418-2978
(866) 500-2186
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
RI
Other
Enumeration date
06/26/2023
Last updated
06/26/2023
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