Provider Demographics
NPI:1609642545
Name:LICCIARDI, KAISHA
Entity Type:Individual
Prefix:
First Name:KAISHA
Middle Name:
Last Name:LICCIARDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1872 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-1954
Mailing Address - Country:US
Mailing Address - Phone:401-263-7948
Mailing Address - Fax:
Practice Address - Street 1:1872 SMITH ST
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02911-1954
Practice Address - Country:US
Practice Address - Phone:401-263-7948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula