Provider Demographics
NPI:1053474486
Name:LICHY DE LICHY, BRIGITTE (A P)
Entity Type:Individual
Prefix:MRS
First Name:BRIGITTE
Middle Name:
Last Name:LICHY DE LICHY
Suffix:
Gender:F
Credentials:A P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17150 N. E. 171ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162
Mailing Address - Country:US
Mailing Address - Phone:305-944-1290
Mailing Address - Fax:305-944-1236
Practice Address - Street 1:17150 N. E. 171ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162
Practice Address - Country:US
Practice Address - Phone:305-944-1290
Practice Address - Fax:305-944-1236
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1263171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist