Lisa Klewicki, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810002980 Issued in VA

Practice address

450 W Broad St Ste 211
Falls Church, VA 22046-3318

Phone

(571) 277-4919

Fax

(703) 241-1122

NPI assigned

Sep 3, 2016

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

Opted out of Medicare

Yes, effective Jun 14, 2024 through Jun 14, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fountain of Life LLC

  • Clinical Psychologist
  • Falls Church, VA
  • NPI 1396286019
  NPD (past) Authorized official

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

{
    "created_epoch": "1472860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472860800000",
    "number": "1265989503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 W BROAD ST STE 211",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220463318",
            "telephone_number": "571-277-4919",
            "fax_number": "703-241-1122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 W BROAD ST STE 211",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220463318",
            "telephone_number": "571-277-4919",
            "fax_number": "703-241-1122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLEWICKI",
        "first_name": "LISA",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-03",
        "last_updated": "2016-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810002980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mert Tugrul Kivanc, D.O.
• Katrina Klag, PHARMD
• Jonathan Klein, M.D.
• Klemm Chiropractic Center, P.C.
• Jerald William Klemm, DC
• Elizabeth Kline, MD
• Katie Mae Kline, MSN APRN CPNP-AC
• Timothy A Kline, M.D.
• Christine Klingaman, D.O.
• Trevor Ralph Klinkner

• Clinical Psychologist in Falls Church, VA
• Providers in Falls Church, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.