Individual
MRS. LISA ANN LICARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
121 MANOR RD, GARDEN CITY, NY 11530-2410
(516) 270-2879
Mailing address
121 MANOR RD, GARDEN CITY, NY 11530-2410
(516) 270-2879
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
005632
NY
133V00000X
Registered Dietitian
Primary
005632
NY
133VN1005X
Renal Nutrition Registered Dietitian
005632
NY
Other
Enumeration date
07/10/2008
Last updated
07/10/2008
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