Individual
BETSY DORIA LILJEBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYNP
Contact information
Practice address
1427 GENESEE ST, UTICA, NY 13501-4343
(315) 738-1428
(315) 738-1461
Mailing address
1020 MARY ST, UTICA, NY 13501-1930
(315) 724-6907
(315) 733-0791
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F400834-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00474180
—
NY
05
—
01039156
—
NY
Enumeration date
05/16/2006
Last updated
09/18/2008
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