Kristin Boyle Licardi, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

077858 Issued in NY

Practice address

400 Doansburg Rd
Brewster, NY 10509-5902

Phone

(845) 279-2995

NPI assigned

Jan 10, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1326153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326153600000",
    "number": "1104196997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 BEERS DR",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109404222",
            "telephone_number": "845-279-2995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 DOANSBURG RD",
            "city": "BREWSTER",
            "state": "NY",
            "postal_code": "105095902",
            "telephone_number": "845-279-2995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICARDI",
        "first_name": "KRISTIN",
        "middle_name": "BOYLE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-10",
        "last_updated": "2012-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "077858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer A Latterner, BSW
• Simone Michele Lawrence, PMHNP
• Howard Lee, MD
• Justin Letizia, ATC
• Sara Levin, LMSW
• Alix Y Lieb
• Lou Lindenbaum, PHD
• Jacqueline Konstandina Lintzeris, LMSW
• Terri-Ann C Lisa, R.N.
• Yaakov Y Liss, M.D.

• Clinical Social Worker in Brewster, NY
• Providers in Brewster, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.