Individual provider Active NPI

Lisa Resnick, LCSW-C

  • Clinical Social Worker
  • Gaithersburg, MD
National Provider Identifier
1306177803
Registry record updated Jan 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
10667 Issued in MD
Practice address
610 E Diamond Ave
Suite 100a
Gaithersburg, MD 20877-5321
Phone
(301) 840-3200
Fax
(301) 840-1348
NPI assigned
Jan 22, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2010

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 10667 MD Primary

Addresses

Primary practice location

610 E Diamond Ave
Suite 100a
Gaithersburg, MD 20877-5321

Mailing address

610 E Diamond Ave
Suite 100a
Gaithersburg, MD 20877-5321
Phone (301) 840-3200

Other identifiers 1

IdentifierTypeStateIssuer
816700100MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
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
I20120507000288 DC Practitioner - Clinical Social Worker 3173785219 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Willow Oak Therapy Center, IncGroup PAC ID 5698661023, 18 clinicians

Practice addresses (Care Compare)

15701 Crabbs Branch Way
Rockville, MD 20855-2634
Phone (301) 251-8965

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10667MDMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Washington Assessment & Therapy Services Past Accepting new patients
Jody Tabner Thayer LLC Clinical PastSince Feb 8, 2017 Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1264118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1264118400000",
    "number": "1306177803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 E DIAMOND AVE",
            "address_2": "SUITE 100A",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208775321",
            "telephone_number": "301-840-3200",
            "fax_number": "301-840-1348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 E DIAMOND AVE",
            "address_2": "SUITE 100A",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208775321",
            "telephone_number": "301-840-3200",
            "fax_number": "301-840-1348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RESNICK",
        "first_name": "LISA",
        "name_prefix": "Mrs.",
        "credential": "LCSW-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-22",
        "last_updated": "2010-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "10667",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "816700100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gaithersburg, MD

Sources for this page

Verify at the official NPI Registry.