Provider Demographics
NPI:1477980415
Name:LICATA, CAMILLE MARIE (NP)
Entity Type:Individual
Prefix:MS
First Name:CAMILLE
Middle Name:MARIE
Last Name:LICATA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:700 RTE 46 E
Mailing Address - Street 2:STE 450
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004
Mailing Address - Country:US
Mailing Address - Phone:973-559-3700
Mailing Address - Fax:973-559-3700
Practice Address - Street 1:825 BLOOMFIELD AVE
Practice Address - Street 2:STE LL-1
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1366
Practice Address - Country:US
Practice Address - Phone:973-233-4493
Practice Address - Fax:973-233-4505
Is Sole Proprietor?:No
Enumeration Date:2013-10-06
Last Update Date:2021-08-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00765000363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health