{
"Npi": {
"NPI": "1437326253",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "LICIAGA",
"FirstName": "NELLIE",
"MiddleName": "E.",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LCSW, M-CASAC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "LEDERER",
"OtherFirstName": "ELAINE",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "EXECUTIVE DIRECTOR",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "520 E 142ND ST APT 4A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BRONX",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10454-2156",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "347-256-8205",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "9729 64TH RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "REGO PARK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11374-2259",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-896-3400",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/12/2008",
"LastUpdateDate": "02/10/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
"LicenseNumber": "12366",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}