Mara Ann Kent-Licardi, LCSWR

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R074102-1 Issued in NY

Practice address

200 Midway Park Dr
Middletown, NY 10940-2642

Phone

(845) 343-7274

Fax

(845) 343-4545

NPI assigned

May 2, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 6, 2023 through Jul 6, 2027

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.

• Jack R Nizewitz & Gary J Lake PC

  • Optometrist
  • Middletown, NY
  • NPI 1952528457
  NPD (past)

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1518188952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1222",
            "city": "PINE BUSH",
            "state": "NY",
            "postal_code": "125661222",
            "telephone_number": "914-805-7677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MIDWAY PARK DR",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109402642",
            "telephone_number": "845-343-7274",
            "fax_number": "845-343-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENT-LICARDI",
        "first_name": "MARA",
        "middle_name": "ANN",
        "credential": "LCSWR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R074102-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jean Elizabeth Kellner, RN
• Brianne L Kelly
• Shakia Kelly, RN
• Stacey Kennedy, LMSW
• Peter J Kennelty, C.O.T.A.
• Arriana Kerr
• Anila Khaliq, MD
• Maryam Khaliq, PA-C
• Alia Khamis, MD
• Erum Shujaat Khan, MD

• Clinical Social Worker in Middletown, NY
• Providers in Middletown, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.