Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mark David Licitra, LCSW

Individual provider Clinical Social Worker · NPI 1568821973

Mark David Licitra, LCSW is a Clinical Social Worker in Portland, Oregon. Works from 2 locations. Licensed in Hawaii and Washington.

Licensed in
HI, WA
In the registry since
2016
Specialties on file
2
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

8613 SE 8th Ave
Portland, OR 97202-7002
Phone: (215) 490-6557
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3710 Sw Us Veterans Hospital Rd, Portland, OR 97239-2964 — (503) 220-8262

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 3920 (HI)
Clinical Social Worker Taxonomy 1041C0700X · Licence LW61618529 (WA)

Record details

NPI number1568821973
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorNo
NPI enumeratedFebruary 12, 2016
Last updated in NPPESMay 19, 2025
Certification dateMay 19, 2025

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