Individual
MARK DAVID LICITRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
8613 SE 8TH AVE, PORTLAND, OR 97202-7002
(215) 490-6557
Mailing address
8613 SE 8TH AVE, PORTLAND, OR 97202-7002
(215) 490-6557
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3920
HI
1041C0700X
Clinical Social Worker
LW61618529
WA
Other
Enumeration date
02/12/2016
Last updated
05/19/2025
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