Provider Demographics
NPI:1407130909
Name:BRETT M. LIQUORI, LICENSED PSYCHOLOGIST, PC
Entity Type:Organization
Organization Name:BRETT M. LIQUORI, LICENSED PSYCHOLOGIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:M
Authorized Official - Last Name:LIQUORI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:631-444-5354
Mailing Address - Street 1:12 WESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2837
Mailing Address - Country:US
Mailing Address - Phone:631-444-5354
Mailing Address - Fax:631-444-5354
Practice Address - Street 1:12 WESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2837
Practice Address - Country:US
Practice Address - Phone:631-444-5354
Practice Address - Fax:631-444-5354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014010-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty