Individual
CHARLES LICCESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1816 ALBERMARLE AVE, EAST MEADOW, NY 11554-1617
(516) 315-1641
Mailing address
1816 ALBERMARLE AVE, EAST MEADOW, NY 11554-1617
(516) 315-1641
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F405204-01
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/01/2022
Last updated
09/26/2023
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