Individual
MRS. ANGELICA J LICCIARDI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
3253 ROUTE 112, MEDFORD, NY 11763-1411
(631) 730-3737
Mailing address
19 MAPLE AVE, BELLPORT, NY 11713-2010
(631) 294-3178
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
116074
NY
Other
Enumeration date
06/06/2022
Last updated
06/06/2022
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