Provider Demographics
NPI:1982487112
Name:DECANINI, LIZZ VALERIA
Entity type:Individual
Prefix:
First Name:LIZZ
Middle Name:VALERIA
Last Name:DECANINI
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 1:1360 SHELDON DR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4981
Mailing Address - Country:US
Mailing Address - Phone:720-751-3483
Mailing Address - Fax:
Practice Address - Street 1:1360 SHELDON DR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80229-4981
Practice Address - Country:US
Practice Address - Phone:720-751-3483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician