David Reed Lysakowski, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149009090 Issued in IL

Practice address

5900 Bond Ave
Centreville, IL 62207-2326

Phone

(619) 332-5302

Fax

(618) 332-5285

NPI assigned

Mar 23, 2021

Last updated

Mar 23, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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": "1616457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616457600000",
    "number": "1245816826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 BOND AVE",
            "city": "CENTREVILLE",
            "state": "IL",
            "postal_code": "622072326",
            "telephone_number": "619-332-5302",
            "fax_number": "618-332-5285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 BOND AVE",
            "city": "CENTREVILLE",
            "state": "IL",
            "postal_code": "622072326",
            "telephone_number": "619-332-5302",
            "fax_number": "618-332-5285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYSAKOWSKI",
        "first_name": "DAVID",
        "middle_name": "REED",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-23",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149009090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Centreville",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5900 Bond Ave",
            "city": "Centreville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622072326",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Clinical Social Worker in Centreville, IL
• Providers in Centreville, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2021; 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.