| Licini Inc | |
|
782 Foxridge Center Drive Orange Park FL 32065 | |
| (904) 637-1400 | |
| (904) 800-4880 |
| Full Name | Licini Inc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 782 Foxridge Center Drive, Orange Park, Florida |
| Authorized Official Name and Position | Kerri S Licini (OWNER/DIRECTOR) |
| Authorized Official Contact | 9046371400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Licini Inc 782 Foxridge Center Drive Orange Park FL 32065 Ph: (904) 637-1400 | Licini Inc 782 Foxridge Center Drive Orange Park FL 32065 Ph: (904) 637-1400 |
| NPI Number | 1316509896 |
|---|---|
| Provider Enumeration Date | 07/03/2019 |
| Last Update Date | 03/15/2023 |
| Certification Date | 03/15/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316509896 | NPI | - | NPPES |
| 1-13-14323 | Other | 1-13-14323 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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