Individual
CASEY M GALLAGHER-LICITRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, PMHNP
Contact information
Practice address
201 E GREEN ST, ITHACA, NY 14850-5635
(607) 274-6200
Mailing address
102 ARMSTRONG RD, LANSING, NY 14882-8904
(607) 427-9970
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
736778
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F405994
NY
Other
Enumeration date
03/05/2018
Last updated
01/07/2025
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