MEDICARE: ESTHER MARIE LICEAGA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1912442351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTHER MARIE LICEAGA

Provider Business Mailing Address
First Line	:	8205 SW 11TH CT
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-3418
Country	:	US
Telephone Number	:	787-231-6166
Fax Number	:

Provider Business Practice Location Address
First Line	:	8205 SW 11TH CT
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-3418
Country	:	US
Telephone Number	:	787-231-6166
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2016
Last Update Date	:	12/20/2016

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Directions to “ ESTHER MARIE LICEAGA ” Practice Location

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