Healthcare Provider Details

I. General information

NPI: 1568947026
Provider Name (Legal Business Name): ANNA LICCIARDO ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 MAPLE AVE STE 202
RED BANK NJ
07701-1731
US

IV. Provider business mailing address

102 CRANBROOK CT
HOLMDEL NJ
07733-2756
US

V. Phone/Fax

Practice location:
  • Phone: 732-660-8337
  • Fax:
Mailing address:
  • Phone: 732-245-5645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number000628
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00176600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: