Provider Demographics
NPI:1043574429
Name:LICARI, ADRIENNE NICOLE (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:NICOLE
Last Name:LICARI
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 EAST MAIN STREET
Mailing Address - Street 2:SUITE #3
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2919
Mailing Address - Country:US
Mailing Address - Phone:631-406-3139
Mailing Address - Fax:
Practice Address - Street 1:249 EAST MAIN STREET
Practice Address - Street 2:SUITE #3
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11766-2919
Practice Address - Country:US
Practice Address - Phone:631-406-3139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR056808101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional