MARY E TICKNOR (LCSW, LICSW) – Clinical Social Worker, NPI 1003857079
Clinical Social Worker
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,510 CLINICAL SOCIAL WORKER in IL
Provider Addresses for MARY E TICKNOR (LCSW, LICSW)
1720 N LA SALLE DR APT 22
CHICAGO, IL 606145845
Phone: (413) 374-6135
Fax: (888) 335-8179
Type: Location
1440 Renaissance Dr Ste 320
Park Ridge, IL 600681471
Phone: (847) 759-9100
Fax: (224) 985-2119
Type: Location
57, Gothic Street, Northampton, Hampshire County, Massachusetts, 01060, United States
NORTHAMPTON, MA 010603047
Phone: (413) 584-0110
Fax: (413) 584-0027
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-11-08
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20051012000594 | I | Clinical Social Worker | MA | TBD |
| I20210528000406 | I | Clinical Social Worker | IL | TBD |
| I20241108000688 | I | Clinical Social Worker | ME | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 60614)
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