Individual
MRS. RENEE LICORISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, APRN, PMHNP-BC
Contact information
Practice address
343 4TH AVE, BROOKLYN, NY 11215-2719
(929) 470-9881
Mailing address
17460 I-35N, SUITE 430-419, SCHERTZ, TX 78154
(832) 623-8131
(855) 631-4341
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
405792
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP140787
TX
Other
Enumeration date
03/13/2019
Last updated
12/31/2024
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