Individual
KANDACE R LICCIARDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
392 SEGUINE AVE, STATEN ISLAND, NY 10309-3906
(718) 226-2275
Mailing address
392 SEGUINE AVE, STATEN ISLAND, NY 10309-3906
(718) 226-2275
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
285000
NY
Other
Enumeration date
04/09/2012
Last updated
11/14/2019
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