Active NPI
Carly Ann Licameli, M.A., CCC-SLP
- Speech-Language Pathologist
- Nutley, NJ
National Provider Identifier
1326560772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 14094243
- Practice address
- 108 Conover Ave
Nutley, NJ 07110-3398 - Phone
- (973) 204-8045
- NPI assigned
- Jul 7, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 14094243 | NJ | Primary |
Addresses
Primary practice location
108 Conover Ave
Nutley, NJ 07110-3398
Mailing address
108 Conover Ave
Nutley, NJ 07110-3398
Phone (973) 204-8045
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14094243 | NJ | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1499385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1326560772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 CONOVER AVE",
"city": "NUTLEY",
"state": "NJ",
"postal_code": "071103398",
"telephone_number": "973-204-8045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 CONOVER AVE",
"city": "NUTLEY",
"state": "NJ",
"postal_code": "071103398",
"telephone_number": "973-204-8045"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICAMELI",
"first_name": "CARLY",
"middle_name": "ANN",
"credential": "M.A., CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-07-07",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NJ",
"license": "14094243",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nutley, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.