Provider Demographics
NPI:1518013895
Name:LIQUORI, BRETT M (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:M
Last Name:LIQUORI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:631-675-0377
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:631-675-0377
Practice Address - Fax:631-444-5354
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014010-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical