Individual
MARIA THERESA LIQUETE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2460 CURTIS ELLIS DR, ROCKY MOUNT, NC 27804-2237
(252) 962-8000
Mailing address
220 STANDIFORD AVE STE F, MODESTO, CA 95350-1159
(812) 604-5870
(209) 579-5637
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
0101244357
VA
2084P0800X
Psychiatry Physician
Primary
2016-00646
NC
2084P0800X
Psychiatry Physician
39490
TN
2084P0800X
Psychiatry Physician
C131074
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1435-320
—
WI
05
—
3331581
—
TN
05
—
3331589
—
TN
01
—
4114432
BCBS
TN
Enumeration date
04/22/2006
Last updated
09/29/2025
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