Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | R 021232-1 | NY |
NPI | 1003017336 |
---|---|
Provider Name | Ms. Alvita Liktorius |
First Address | Hastings On Hudson, NY 10706-1704 |
Second Address | New York, NY 10011-8858 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 08/07/2007 |