Vincent Charles Licata III, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW7633 Issued in FL

Practice address

330 SW 27TH Ave
Fort Lauderdale, FL 33312-2051

Phone

(954) 791-4300

NPI assigned

Oct 16, 2009

Sex

Male

Sole proprietor

Yes

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 FL

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, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Henderson Behavioral Health, Inc.Group PAC ID 4688574643, 21 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Henderson Behavioral Health, Inc.

  • Community/Behavioral Health Agency
  • Lauderdale Lakes, FL
  • NPI 1972533271
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1255651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1891020368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4740 N STATE ROAD 7",
            "city": "LAUDERDALE LAKES",
            "state": "FL",
            "postal_code": "333195839",
            "telephone_number": "954-486-4005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 SW 27TH AVE",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333122051",
            "telephone_number": "954-791-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICATA",
        "first_name": "VINCENT",
        "middle_name": "CHARLES",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-10-16",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW7633",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "SW7633",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Liberty Medical, LLC (AptivaRx)
• Liberty Medical, LLC (Aptiva Medical)
• Liberty Pharmacy LLC
• Beatriz A. Libos, PA-C
• Steven Licata, DO
• Moises Lichtinger, MD
• Debra S Lichtman, RN
• Zeljka Licina, DDS
• Brianna Lieberberg
• Anneli B. Liebig, ARNP

• Clinical Social Worker in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; 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.