MARK DAVID LICITRA

PORTLAND, OR
NPI1568821973
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy1041C0700X Social Worker, Clinical
(Licence: HI  3920)
Enumeration Date2016-02-12
Last Update Date2016-02-12
Business Address
-- MARK DAVID LICITRA lcsw
3710 SW US VETERAN HOSPITAL RD.
PORTLAND, OR 97239
Phone number: 503-220-8262
Mailing Address
-- MARK DAVID LICITRA lcsw
3710 SW US VETERAN HOSPITAL RD.
PORTLAND, OR 97239
Phone number:
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