Individual
BRIANNA KATHLEEN LIVELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
120 EAST DR, NORTH MASSAPEQUA, NY 11758-1640
(516) 473-6639
Mailing address
120 EAST DR, NORTH MASSAPEQUA, NY 11758-1640
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
12/16/2018
Last updated
07/30/2023
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