Provider Demographics
NPI:1962775262
Name:LICATA, FRANCINE M
Entity type:Individual
Prefix:
First Name:FRANCINE
Middle Name:M
Last Name:LICATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 30
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230
Mailing Address - Country:US
Mailing Address - Phone:413-528-9311
Mailing Address - Fax:413-644-0274
Practice Address - Street 1:11 QUARRY HILL ROAD
Practice Address - Street 2:
Practice Address - City:LEE
Practice Address - State:MA
Practice Address - Zip Code:01238
Practice Address - Country:US
Practice Address - Phone:413-243-0536
Practice Address - Fax:413-243-8040
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA114559101Y00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110109519AMedicaid