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General NPI Number Information
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NPI Number | 1225759871
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Entity Type | Organization
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Legal Business Name | BRIAN LICORISH PSYCHIATRY LLC
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 5201 GREAT AMERICA PKWY STE 320
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City | SANTA CLARA
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State | CA
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Zip | 95054-1140
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Country | US
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Telephone | 408-384-3758
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Fax |
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Provider Business Mailing Address
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Address Line | 2108 N ST STE N
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City | SACRAMENTO
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State | CA
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Zip | 95816-5712
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | KENRICK BRIAN LICORISH
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Credential | MD
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Telephone | 949-244-0104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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