Provider Demographics
NPI:1578252011
Name:VINCIFORA, LIAM EDWARD (CIT)
Entity Type:Individual
Prefix:
First Name:LIAM
Middle Name:EDWARD
Last Name:VINCIFORA
Suffix:
Gender:M
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 1/2 W 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7443
Mailing Address - Country:US
Mailing Address - Phone:985-276-4165
Mailing Address - Fax:985-400-2333
Practice Address - Street 1:1016 1/2 W 21ST AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7443
Practice Address - Country:US
Practice Address - Phone:985-276-4165
Practice Address - Fax:985-400-2333
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5354101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)