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General NPI Number Information
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NPI Number | 1912062191
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Entity Type | Individual
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Provider Name | RICHARD F LIOTTA PH.D.
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Gender | Male
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 88 WOODRUFF ST
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City | SARANAC LAKE
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State | NY
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Zip | 12983-1713
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Country | US
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Telephone | 518-891-0924
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Fax | 518-327-3092
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Provider Business Mailing Address
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Address Line | PO BOX 229 703 COUNTY RTE 60
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City | RAINBOW LAKE
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State | NY
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Zip | 12976-0229
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Country | US
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Telephone | 518-327-3702
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Fax | 518-327-3092
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 010490
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License Number State | NY
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