Liline Theagene

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

350 5TH Ave
New York, NY 10118-0110

Phone

(610) 483-7518

NPI assigned

Dec 3, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1733184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739750400000",
    "number": "1750107967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 45TH ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 5TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "101180110",
            "telephone_number": "610-483-7518"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Universal City Plz",
            "address_purpose": "LOCATION",
            "city": "Universal City",
            "state": "CA",
            "postal_code": "916081002",
            "country_code": "US",
            "telephone_number": "610-483-7518",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 45th St S Ste 318",
            "address_purpose": "LOCATION",
            "city": "Fargo",
            "state": "ND",
            "postal_code": "581036511",
            "country_code": "US",
            "telephone_number": "610-483-1578",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THEAGENE",
        "first_name": "LILINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-12-03",
        "last_updated": "2025-02-17",
        "certification_date": "2025-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "5874",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "568946544",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "236",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The Wave Mental Health Counseling PLLC
• The Wellness Care NP in Family Health PC
• The Woman'S Personal Health Resource, Inc.
• The WTC Mental Health Program
• Carol S Thea, LCSW
• Marie S Theagene
• Thebracedoctorinc.
• Nithin Pollo Joe Theckumparampil, M.D.
• Soe Hlaing Thein, MD
• Caryn J Theiner, DO

• Clinical Social Worker in New York, NY
• Providers in New York, 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 Feb 17, 2025; 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.