NPIMap

Organization Active NPI

Lisa Mustillo Psychotherapy

  • Clinical Social Worker
  • Kennesaw, GA
National Provider Identifier
1275277782
Registry record updated Aug 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
LISA MUSTILLO PSYCHOTHERAPY
Practice address
1301 Shiloh Rd NW Ste 860
Kennesaw, GA 30144-7174
Phone
(917) 992-7896
NPI assigned
Apr 21, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2022

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

Authorized official

Name
Lisa Mustillo, LCSWNPI 1912181132
Title
Licensed Clinical Social Worker
Phone
(917) 992-7896

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

1301 Shiloh Rd NW Ste 860
Kennesaw, GA 30144-7174

Mailing address

180 Montgomery St NE
Marietta, GA 30060-1440
Phone (917) 992-7896

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1650499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660003200000",
    "number": "1275277782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 MONTGOMERY ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601440",
            "telephone_number": "917-992-7896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 SHILOH RD NW STE 860",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301447174",
            "telephone_number": "917-992-7896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISA MUSTILLO PSYCHOTHERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-21",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A",
        "authorized_official_last_name": "MUSTILLO",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "LICENSED CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "917-992-7896",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennesaw, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2022; 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.