Individual
MS. GINA M LICCIARDELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
610 MILLERS HILL, KENNET SQUARE, PA 19348
(610) 444-5879
(610) 444-5079
Mailing address
747 BRADFORD TERRACE, WEST CHESTER, PA 19382-1803
(610) 444-5879
(610) 444-5079
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
PC001538
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PC001538
BUREAU OF PROFESSIONAL AN
PA
Enumeration date
05/08/2007
Last updated
07/08/2007
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