Provider Demographics
NPI:1932306735
Name:LICCIARDI, TERRENCE III (RPA)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:
Last Name:LICCIARDI
Suffix:III
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-3232
Mailing Address - Country:US
Mailing Address - Phone:978-521-0998
Mailing Address - Fax:
Practice Address - Street 1:23 STILES RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2859
Practice Address - Country:US
Practice Address - Phone:603-898-3129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA064812471C3402X, 243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
No243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant