Individual
KAITLIN LICCIARDONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, BCBA
Contact information
Practice address
1019 W 9TH AVE, KING OF PRUSSIA, PA 19406-1215
(610) 992-9900
Mailing address
6100 CITY AVE APT P212, PHILADELPHIA, PA 19131-1239
(732) 429-4674
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-17-26267
PA
Other
Enumeration date
09/28/2017
Last updated
09/28/2017
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