Lisa Packard

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW13499 Issued in FL

Practice address

906 Wingate TRL
Port Orange, FL 32128-7524

Phone

(989) 262-9905

NPI assigned

Jan 25, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1053819953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "906 WINGATE TRL",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321287524",
            "telephone_number": "989-262-9905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "906 WINGATE TRL",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321287524",
            "telephone_number": "989-262-9905"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "125 S Swoope Ave Ste 110",
            "address_purpose": "LOCATION",
            "city": "Maitland",
            "state": "FL",
            "postal_code": "327515784",
            "country_code": "US",
            "telephone_number": "407-622-0444 x513",
            "fax_number": "407-699-0444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PACKARD",
        "first_name": "LISA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-25",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW13499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Ottaviani, D.C.
• Amanda Owen
• Angela M Owens, PT
• Chad Owens, PTA
• Kristi Susann Pace, RBT
• Andrea Soledad Pagan
• Elyssa Naomi Pagan, DC
• Jared R Pagan, RBT
• Heber Paiva, DMD
• Audrey Paladino

• Clinical Social Worker in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.