Active NPI
Gina M Licciardello, LPC
- Counselor
- Kennet Square, PA
National Provider Identifier
1891908653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- PC001538
- Practice address
- 610 Millers Hill
Kennet Square, PA 19348 - Phone
- (610) 444-5879
- Fax
- (610) 444-5079
- NPI assigned
- May 8, 2007
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | PC001538 | PA | Primary |
Addresses
Primary practice location
610 Millers Hill
Kennet Square, PA 19348
Mailing address
747 Bradford Terrace
West Chester, PA 19382-1803
Phone (610) 444-5879
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PC001538 | Other | PA | BUREAU OF PROFESSIONAL AN |
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 |
|---|---|---|---|
| PC001538 | PA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1891908653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "747 BRADFORD TERRACE",
"city": "WEST CHESTER",
"state": "PA",
"postal_code": "193821803",
"telephone_number": "610-444-5879",
"fax_number": "610-444-5079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 MILLERS HILL",
"city": "KENNET SQUARE",
"state": "PA",
"postal_code": "19348",
"telephone_number": "610-444-5879",
"fax_number": "610-444-5079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICCIARDELLO",
"first_name": "GINA",
"middle_name": "M",
"name_prefix": "Ms.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "PA",
"license": "PC001538",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BUREAU OF PROFESSIONAL AN",
"identifier": "PC001538",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kennet Square, PA
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.