Individual provider Active NPI

Lisa Johnson, LCSW

  • Clinical Social Worker
  • Palm Coast, FL
National Provider Identifier
1235771064
Registry record updated Oct 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
26 Pinto LN
Palm Coast, FL 32164-7071
Phone
(386) 586-6801
NPI assigned
Oct 14, 2019
Last updated
Oct 14, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 14, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

26 Pinto LN
Palm Coast, FL 32164-7071

Mailing address

26 Pinto LN
Palm Coast, FL 32164-7071
Phone (386) 586-6801

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200804002700 FL Practitioner - Clinical Social Worker 0941625289 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Presbyterian Counseling Center IncGroup PAC ID 8325370950, 10 clinicians

Practice addresses (Care Compare)

156 Florida Park Dr N
Palm Coast, FL 32137-8317
Phone (386) 258-1618

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Presbyterian Counseling Center Inc CurrentSince Jul 1, 2020 Accepting new patients

Locations

430 Braddock Ave
Daytona Beach, FL 32118
Phone (386) 258-1616

105 Amsden Rd
Ormond Beach, FL 32176

386 S Atlantic Ave
Ormond Beach, FL 32176
Phone (240) 731-6929

156 Florida Park Dr
Palm Coast, FL 32137

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1571011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571011200000",
    "number": "1235771064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 PINTO LN",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321647071",
            "telephone_number": "386-586-6801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 PINTO LN",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321647071",
            "telephone_number": "386-586-6801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "LISA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-14",
        "last_updated": "2019-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Coast, FL

Sources for this page

Verify at the official NPI Registry.