Casey M Gallagher-Licitra, RN, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

F405994 Issued in NY

Practice address

201 E Green St
Ithaca, NY 14850-5635

Phone

(607) 274-6200

NPI assigned

Mar 5, 2018

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

Other names 1

• Casey Gallagher Former name

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Tompkins CountyGroup PAC ID 0143210443, 19 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cayuga Medical Center at Ithaca Hospital, Ithaca, NY, CCN 330307

Medicare enrollment (NPD)

Enrolled

Credentials

Registered Nurse

State licenses

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 and National Provider Directory roles.

• Tompkins County

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Ithaca, NY
  • NPI 1588686596

  Single Specialty

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Cayuga Medical Center at Ithaca

  • General Acute Care Hospital
  • Ithaca, NY
  • NPI 1962422733
  Care Compare affiliation

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

{
    "created_epoch": "1520208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736208000000",
    "number": "1215439336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 ARMSTRONG RD",
            "city": "LANSING",
            "state": "NY",
            "postal_code": "148828904",
            "telephone_number": "607-427-9970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E GREEN ST",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148505635",
            "telephone_number": "607-274-6200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Dates Dr",
            "address_purpose": "LOCATION",
            "city": "Ithaca",
            "state": "NY",
            "postal_code": "148501342",
            "country_code": "US",
            "telephone_number": "607-274-4011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GALLAGHER-LICITRA",
        "first_name": "CASEY",
        "middle_name": "M",
        "credential": "RN, PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-03-05",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "736778",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F405994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CASEY",
            "last_name": "GALLAGHER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Richard Sebastian Gallagher, LMFT
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• Barbara Lynn Ganzel
• Nelima W Gaonkar, LCSW-R

• Psychiatric/Mental Health Nurse Practitioner in Ithaca, NY
• Providers in Ithaca, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2025; 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.