Active NPI
Kaylan Licausi, ASW
- Social Worker
- Berkeley, CA
National Provider Identifier
1184400285
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 117156
- Practice address
- 3075 Adeline St Ste 280
Berkeley, CA 94703-2580 - Phone
- (510) 981-4100
- NPI assigned
- Sep 5, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 117156 | CA | Primary |
Addresses
Primary practice location
3075 Adeline St Ste 280
Berkeley, CA 94703-2580
Mailing address
490 Lake Park Ave. #16172
Oakland, CA 94610
Phone (510) 914-8884
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 117156 | CA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1693872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773964800000",
"number": "1184400285",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "490 LAKE PARK AVE. #16172",
"city": "OAKLAND",
"state": "CA",
"postal_code": "94610",
"telephone_number": "510-914-8884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3075 ADELINE ST STE 280",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947032580",
"telephone_number": "510-981-4100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICAUSI",
"first_name": "KAYLAN",
"credential": "ASW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-09-05",
"last_updated": "2026-03-20",
"certification_date": "2026-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": "117156",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.