Roberta E. Mirisch, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS 16615 Issued in CA

Practice address

16311 Ventura Blvd Ste 1120
Encino, CA 91436-4356

Phone

(818) 783-4140

NPI assigned

Feb 19, 2010

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 1, 2013 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1266537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288051200000",
    "number": "1215259130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16311 VENTURA BLVD STE 1120",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914364356",
            "telephone_number": "818-783-4140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16311 VENTURA BLVD STE 1120",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914364356",
            "telephone_number": "818-783-4140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRISCH",
        "first_name": "ROBERTA",
        "middle_name": "E.",
        "name_prefix": "Ms.",
        "credential": "L.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-02-19",
        "last_updated": "2010-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS 16615",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF CALIFORNIA",
            "identifier": "95-4436501",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maxine Mintzer
• Miracle Board and Care&Asssisted Living
• Miracle Mile Medical Center
• Venus Mirbod, PSY.D.
• Ali Mirfakhrai, D.C.
• Haris Mirza
• Misra Medical Corp
• Sulagna Misra, M.D.
• Helen Mitchell
• Susan Margaret Mitchell, PHD MFT

• Clinical Social Worker in Encino, CA
• Providers in Encino, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.