Provider Demographics
NPI:1053530022
Name:PANTEN-LICKER, BRIGITTE (MD)
Entity type:Individual
Prefix:DR
First Name:BRIGITTE
Middle Name:
Last Name:PANTEN-LICKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 BABBITT RD APT 2B
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10507-2050
Mailing Address - Country:US
Mailing Address - Phone:914-864-1467
Mailing Address - Fax:914-734-2494
Practice Address - Street 1:1040 MAIN ST
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2906
Practice Address - Country:US
Practice Address - Phone:914-737-8217
Practice Address - Fax:914-734-2494
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156899103TP0016X
103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY156899OtherSTATE LICENSE