Individual
PIERRE L LICIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
15 EDDIE AVE, NORTH BABYLON, NY 11703-2712
(631) 586-2865
Mailing address
15 EDDIE AVE, NORTH BABYLON, NY 11703-2712
(631) 586-2865
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
004355
NY
Other
Enumeration date
10/23/2008
Last updated
10/23/2008
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