Kerri S. Licini, MA, MAED., BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Practice address

782 Foxridge Center Dr
Orange Park, FL 32065-5776

Phone

(904) 637-1400

Fax

(904) 800-4880

NPI assigned

Dec 6, 2010

Last updated

Jul 28, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Licini Inc

  • Behavior Analyst
  • Orange Park, FL
  • NPI 1316509896
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1291593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722124800000",
    "number": "1003119504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "782 FOXRIDGE CENTER DR",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320655776",
            "telephone_number": "904-637-1400",
            "fax_number": "904-637-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "782 FOXRIDGE CENTER DR",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320655776",
            "telephone_number": "904-637-1400",
            "fax_number": "904-800-4880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICINI",
        "first_name": "KERRI",
        "middle_name": "S.",
        "name_prefix": "Mrs.",
        "credential": "MA, MAED., BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-12-06",
        "last_updated": "2024-07-28",
        "certification_date": "2024-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "1-13-14323",
            "identifier": "1-13-14323",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "liciniinc.com",
            "affiliation": "N",
            "address_1": "782 Foxridge Center Dr",
            "city": "Orange Park",
            "state": "FL",
            "country_code": "US",
            "postal_code": "320655776",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Pamela J Lewis
• Stephanie Tramaine Lewis, COTA
• Eniola O Leyimu, PHARM.D
• Marilyn Leyva Fernandez, RDH
• Licini Inc
• Samantha Licini
• Life Care Centers of America, Inc. (Life Care Center at Wells Crossing)
• Life Changing Solutions
• Life Changing Solutions
• Jazmyne Life

• Behavior Analyst in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.