MEDICARE: PATRICIA ALBRECHT-LICCIARDI M.S.

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	171M00000X	Case Manager/Care Coordinator
2	235Z00000X	Speech-Language Pathologist	006102-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30-0213081	OTHER	NY	TAX ID

General Provider Information

NPI Number	:	1417003351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA ALBRECHT-LICCIARDI M.S.

Provider Business Mailing Address
First Line	:	111 WESTFALL RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-4647
Country	:	US
Telephone Number	:	585-753-5437
Fax Number	:	585-324-1674

Provider Business Practice Location Address
First Line	:	111 WESTFALL RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-4647
Country	:	US
Telephone Number	:	585-753-5437
Fax Number	:	585-324-1674

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	04/19/2021

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Directions to “ PATRICIA ALBRECHT-LICCIARDI M.S.” Practice Location

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