Mariela Licon, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW131192 Issued in CA

Practice address

1500 N Waterman Ave
San Bernardino, CA 92404-5111

Phone

(909) 703-4099

NPI assigned

Aug 28, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St. John'S Community HealthGroup PAC ID 2961482690, 151 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• St. Johns Community Health

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1073653630
  Medicare reassignment Care Compare group NPD
• St. Johns Community Health

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1013057371
  NPD
• St. Johns Community Health

  • Community Health Clinic/Center
  • Los Angeles, CA
  • NPI 1073363768
  NPD
• St. Johns Community Health

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1093278632
  NPD (past)
• St. Johns Community Health

  • Federally Qualified Health Center (FQHC)
  • San Bernardino, CA
  • NPI 1780376947
  NPD (past)

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

{
    "created_epoch": "1472342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1497201602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 N WATERMAN AVE",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924045111",
            "telephone_number": "909-703-4099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 N WATERMAN AVE",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924045111",
            "telephone_number": "909-703-4099"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10000 County Farm Rd",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925033508",
            "country_code": "US",
            "telephone_number": "951-358-4400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LICON",
        "first_name": "MARIELA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-28",
        "last_updated": "2025-09-11",
        "certification_date": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW131192",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "131192",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Life Care Home Health

• Clinical Social Worker in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 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.