Individual
BETHANY LILLIQUIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
333 E 43RD ST, LOBBY SUITE 1, NEW YORK, NY 10017-4831
(917) 409-7637
Mailing address
333 E 43RD ST, LOBBY SUITE 1, NEW YORK, NY 10017-4831
(917) 409-7637
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
019268
NY
Other
Enumeration date
09/08/2011
Last updated
01/05/2015
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