Provider Demographics
NPI:1285323709
Name:COGLIANDRO, LUCA
Entity type:Individual
Prefix:
First Name:LUCA
Middle Name:
Last Name:COGLIANDRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 BEL MARIN KEYS BLVD
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-5331
Mailing Address - Country:US
Mailing Address - Phone:415-858-5467
Mailing Address - Fax:
Practice Address - Street 1:941 BEL MARIN KEYS BLVD
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-5331
Practice Address - Country:US
Practice Address - Phone:415-858-5467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst