National Provider Identifier
Casey M Gallagher-Licitra, RN, PMHNP
Casey M Gallagher-Licitra, RN, PMHNP is listed in the NPPES registry with a primary specialty of Psychiatric/Mental Health Nurse Practitioner in Ithaca, NY and a listed phone number of (607) 274-6200.
Profile Overview
- NPI
- 1215439336
- Provider Type
- Individual
- Primary Specialty
- Psychiatric/Mental Health Nurse Practitioner
- Enumeration Date
- March 05, 2018
- Last Updated
- January 07, 2025
Practice Location
- 201 E Green St
- Ithaca, NY 14850-5635
Phone: (607) 274-6200
Mailing Address
- 102 Armstrong RD
- Lansing, NY 14882-8904
Specialties
- Psychiatric/Mental Health Nurse Practitioner (363LP0808X)
- Registered Nurse (163W00000X)
Full Record
- NPI
- 1215439336
- Entity Type
- Individual
- Last Name
- Gallagher-Licitra
- First Name
- Casey
- Middle Name
- M
- Credential
- RN, PMHNP
- Provider Other Last Name
- Gallagher
- Provider Other First Name
- Casey
- Provider Other Last Name Type Code
- 1
- Mailing Street Address
- 102 Armstrong RD
- Mailing City
- Lansing
- Mailing State
- NY
- Mailing ZIP Code
- 14882-8904
- Mailing Country
- US
- Mailing Phone
- (607) 427-9970
- Practice Street Address
- 201 E Green St
- Practice City
- Ithaca
- Practice State
- NY
- Practice ZIP Code
- 14850-5635
- Practice Country
- US
- Practice Phone
- (607) 274-6200
- Enumeration Date
- March 05, 2018
- Last Updated
- January 07, 2025
- Sex
- Female
- Sole Proprietor
- Yes
- Taxonomy Group 2
- 193400000X Single Specialty Group
- Certification Date
- January 07, 2025
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Psychiatric/Mental Health Nurse Practitioner (363LP0808X), Registered Nurse (163W00000X)