Provider Demographics
NPI:1952848699
Name:LICOR, GRISEL DE LA CARIDAD
Entity Type:Individual
Prefix:
First Name:GRISEL
Middle Name:DE LA CARIDAD
Last Name:LICOR
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 1:17840 NW 59TH AVE
Mailing Address - Street 2:UNIT 103
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5161
Mailing Address - Country:US
Mailing Address - Phone:786-424-2237
Mailing Address - Fax:
Practice Address - Street 1:17840 NW 59TH AVE
Practice Address - Street 2:UNIT 103
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5161
Practice Address - Country:US
Practice Address - Phone:786-424-2237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst