Provider Demographics
NPI:1568947026
Name:LICCIARDO, ANNA (ND)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:LICCIARDO
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 BROAD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239-3000
Mailing Address - Country:US
Mailing Address - Phone:732-245-5645
Mailing Address - Fax:
Practice Address - Street 1:158 POMFRET ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1800
Practice Address - Country:US
Practice Address - Phone:860-963-2250
Practice Address - Fax:866-281-7088
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000628175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath