Individual
MR. MICHAEL LICCESE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.N.
Contact information
Practice address
5 WEATHERSTONE WAY, SMITHTOWN, NY 11787-2244
(631) 979-0424
Mailing address
5 WEATHERSTONE WAY, SMITHTOWN, NY 11787-2244
(631) 979-0424
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
3806831
NY
Other
Enumeration date
11/09/2012
Last updated
11/09/2012
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