Mary E Ticknor, LCSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

113177 Issued in MA

Practice address

1720 N la Salle Dr Apt 22
Chicago, IL 60614-5845

Phone

(413) 374-6135

Fax

(888) 335-8179

NPI assigned

Jun 9, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MA, IL, ME3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Clinical Social Worker

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

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

• Stepping Stones Psychiatry, LLC

  • Psychiatry Physician
  • West Springfield, MA
  • NPI 1679155923
  NPD
• The Juniper Center PC

  • Mental Health Counselor
  • Park Ridge, IL
  • NPI 1902906324
  NPD (past)

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675900800000",
    "number": "1003857079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 N LA SALLE DR APT 22",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606145845",
            "telephone_number": "413-374-6135",
            "fax_number": "888-335-8179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 N LA SALLE DR APT 22",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606145845",
            "telephone_number": "413-374-6135",
            "fax_number": "888-335-8179"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1440 Renaissance Dr Ste 320",
            "address_purpose": "LOCATION",
            "city": "Park Ridge",
            "state": "IL",
            "postal_code": "600681471",
            "country_code": "US",
            "telephone_number": "847-759-9100 x104",
            "fax_number": "224-985-2119",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TICKNOR",
        "first_name": "MARY",
        "middle_name": "E",
        "credential": "LCSW, LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-09",
        "last_updated": "2023-02-09",
        "certification_date": "2023-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149023194",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "113177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lawrence Clinton Tice, LCSW
• Uta J Tichawa, RN, APN-BC, ANP
• Kathleen Ticho, LCSW
• Ticiyotl Counseling Services, PC
• Pamela Louise Tickel, DC
• Tidal Nutrition and Recovery, PLLC
• Tides Counseling Chicago, PLLC
• Tides Mental Health of Il, PLLC
• Nichell Tidwell, M.D.
• Eric Tiede, MD

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.