Individual
ANTHONY LICEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9002 161ST ST, JAMAICA, NY 11432-6108
(718) 520-1513
(718) 520-6460
Mailing address
79 GLENRIDGE RD, GLENVILLE, NY 12302-4523
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
39318-T
NY
Other
Enumeration date
10/01/2025
Last updated
10/01/2025
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