Roberto Alejandro Licano, CDCA

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CDCA.171989 Issued in OH

Practice address

120 May Dr
Harrison, OH 45030-2024

Phone

(513) 367-4444

Fax

(513) 367-4449

NPI assigned

Apr 25, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Homefull

  • Case Management Agency
  • Dayton, OH
  • NPI 1598786667
  NPD (past)
• State Line Treatment Services, LLC

  • Community/Behavioral Health Agency
  • Harrison, OH
  • NPI 1497199079
  NPD (past)

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

{
    "created_epoch": "1524614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579132800000",
    "number": "1447748538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 MAY DR",
            "city": "HARRISON",
            "state": "OH",
            "postal_code": "450302024",
            "telephone_number": "513-367-4444",
            "fax_number": "513-367-4449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MAY DR",
            "city": "HARRISON",
            "state": "OH",
            "postal_code": "450302024",
            "telephone_number": "513-367-4444",
            "fax_number": "513-367-4449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICANO",
        "first_name": "ROBERTO",
        "middle_name": "ALEJANDRO",
        "credential": "CDCA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-25",
        "last_updated": "2020-01-16",
        "certification_date": "2020-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "CDCA.171989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0278938",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lees Rehabilitation Services Inc
• Janet Mary Lees, P.T.
• Timothy Bernard Lees, P.T.
• Emily Leininger
• Lisa Lengerich, CNP
• Desiree Long
• Kerrie Lovins, CDCA
• Rachel Lee Lunsford, LPN
• Molly Lysaght, RDN, LD
• Cortney Macdonald, HAS

• Addiction (Substance Use Disorder) Counselor in Harrison, OH
• Providers in Harrison, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.