Individual
NICHOLAS LACIVITA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
613 MARQUETTE RD, BRANDON, MS 39042-3038
(601) 824-0342
Mailing address
PO BOX 157A, WHITFIELD, MS 39193-0157
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
30993
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
MS
Other
Enumeration date
05/26/2021
Last updated
09/11/2024
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