Active NPI
Lisa Ellen Lewis Cavallo, LCSW
- Clinical Social Worker
- Portland, OR
National Provider Identifier
1033253281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 01814
- Practice address
- 6221 NE Fremont St
#103
Portland, OR 97213-4437 - Phone
- (503) 577-1385
- Fax
- (503) 772-4776
- NPI assigned
- Feb 19, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 01814 | OR | Primary |
| Clinical Social Worker | 1041C0700X | LW00005085 | WA | |
| Clinical Social Worker | 1041C0700X | PENDING | MN |
Addresses
Primary practice location
6221 NE Fremont St
#103
Portland, OR 97213-4437
Mailing address
6221 NE Fremont St
#103
Portland, OR 97213-4437
Phone (503) 577-1385
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01814 | Other | OR | LICENSE |
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 |
|---|---|---|---|
| 01814 | OR | MD | Clinical Social Worker |
| LW00005085 | WA | MD | Clinical Social Worker |
| PENDING | MN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Columbia Community Mental Health | Past | Accepting new patients |
Organizations & group practices 1
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.
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- NPI 1861617359
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1033253281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6221 NE FREMONT ST",
"address_2": "#103",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972134437",
"telephone_number": "503-577-1385",
"fax_number": "503-772-4776"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6221 NE FREMONT ST",
"address_2": "#103",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972134437",
"telephone_number": "503-577-1385",
"fax_number": "503-772-4776"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAVALLO",
"first_name": "LISA",
"middle_name": "ELLEN LEWIS",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "01814",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WA",
"license": "LW00005085",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "PENDING",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "01814",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
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.