Active NPI
Lisa Beth Rogers, LCSW
- Clinical Social Worker
- Moodus, CT
National Provider Identifier
1265742597
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 008520
- Practice address
- 16 Rae Palmer Rd
Moodus, CT 06469-1195 - Phone
- (860) 615-6152
- Fax
- (860) 891-8092
- NPI assigned
- Oct 20, 2010
- Last updated
- Feb 4, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 008520 | CT | Primary |
Addresses
Primary practice location
16 Rae Palmer Rd
Moodus, CT 06469-1195
Mailing address
16 Rae Palmer Rd
Moodus, CT 06469-1195
Phone (860) 967-8941
Other practice location 1
11 Wildwood Medical Center
Essex, CT 06426
Phone (860) 615-6152
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 |
|---|---|---|---|
| 008520 | CT | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mindful Therapy Studio LLC | Current | Accepting new patients | |
| Mindful Therapy Studio LLC | Clinical | Current | Accepting new patients |
Locations
16 Rae Palmer Rd
Moodus, CT 06469
Phone (860) 615-6152
Organizations & group practices 2
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.
-
- Adolescent and Children Mental Health Clinic/Center
- Essex, CT
- NPI 1295215093
-
dba The Mindful Therapy Studio
- Clinical Social Worker
- Moodus, CT
- NPI 1447894209
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287532800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580774400000",
"number": "1265742597",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16 RAE PALMER RD",
"city": "MOODUS",
"state": "CT",
"postal_code": "064691195",
"telephone_number": "860-967-8941",
"fax_number": "860-891-8092"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16 RAE PALMER RD",
"city": "MOODUS",
"state": "CT",
"postal_code": "064691195",
"telephone_number": "860-615-6152",
"fax_number": "860-891-8092"
}
],
"practiceLocations": [
{
"address_1": "11 Wildwood Medical Center",
"address_purpose": "LOCATION",
"city": "Essex",
"state": "CT",
"postal_code": "06426",
"country_code": "US",
"telephone_number": "860-615-6152",
"fax_number": "860-891-8092",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROGERS",
"first_name": "LISA",
"middle_name": "BETH",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-10-20",
"last_updated": "2020-02-04",
"certification_date": "2020-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "008520",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moodus, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.