MARK DAVID LICITRA

PORTLAND, OR
NPI1568821973
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy1041C0700X Social Worker, Clinical
(Licence: HI  3920)
Additional Taxonomies1041C0700X Social Worker, Clinical
(Licence: WA  LW61618529)
Enumeration Date2016-02-12
Last Update Date2025-05-19
Business Address
MARK DAVID LICITRA lcsw
8613 SE 8TH AVE
PORTLAND, OR 97202-7002
Phone number: 215-490-6557
Mailing Address
MARK DAVID LICITRA lcsw
8613 SE 8TH AVE
PORTLAND, OR 97202-7002
Phone number: 215-490-6557