Individual
MR. JOSEPH ANTHONY LICAUSI II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
950 CAMPBELL AVE, WEST HAVEN, CT 06516-2770
(203) 932-5711
Mailing address
17 NICHOLAS DR, EAST HAVEN, CT 06512-1145
(203) 843-8149
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
PTN.0007595
CT
Other
Enumeration date
04/10/2020
Last updated
04/10/2020
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