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General NPI Number Information
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NPI Number | 1730296468
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Entity Type | Individual
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Provider Name | PATTI J LICONA LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2063 LA QUINTA DR
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City | INGLESIDE
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State | TX
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Zip | 78362-4301
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Country | US
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Telephone | 361-775-0270
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Fax | 361-775-0270
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Provider Business Mailing Address
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Address Line | 2063 LA QUINTA DR
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City | INGLESIDE
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State | TX
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Zip | 78362-4301
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Country | US
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Telephone | 361-775-0270
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Fax | 361-775-0270
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 22879
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License Number State | TX
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