Provider Demographics
NPI:1972486678
Name:ROMAN LIRIANO, GLENDALICE
Entity type:Individual
Prefix:
First Name:GLENDALICE
Middle Name:
Last Name:ROMAN LIRIANO
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 1:99 ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02125-2727
Mailing Address - Country:US
Mailing Address - Phone:617-373-0808
Mailing Address - Fax:
Practice Address - Street 1:99 ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02125-2727
Practice Address - Country:US
Practice Address - Phone:617-373-0808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty