Active NPI
Elena Beth Licandro, LMSW
- Social Worker
- Hauppauge, NY
National Provider Identifier
1639640394
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 105308
- Practice address
- 1324 Motor Pkwy Ste 104
Hauppauge, NY 11749-5226 - Phone
- (631) 761-6700
- Fax
- (631) 761-6699
- NPI assigned
- Dec 6, 2018
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 105308 | NY | Primary |
Addresses
Primary practice location
1324 Motor Pkwy Ste 104
Hauppauge, NY 11749-5226
Mailing address
1324 Motor Pkwy Ste 104
Hauppauge, NY 11749-5226
Phone (631) 761-6700
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 105308 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1544054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1544054400000",
"number": "1639640394",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1324 MOTOR PKWY STE 104",
"city": "HAUPPAUGE",
"state": "NY",
"postal_code": "117495226",
"telephone_number": "631-761-6700",
"fax_number": "631-761-6699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1324 MOTOR PKWY STE 104",
"city": "HAUPPAUGE",
"state": "NY",
"postal_code": "117495226",
"telephone_number": "631-761-6700",
"fax_number": "631-761-6699"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICANDRO",
"first_name": "ELENA",
"middle_name": "BETH",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-12-06",
"last_updated": "2018-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "105308",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hauppauge, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.