Lisa Kusumpa, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149010909 Issued in IL

Practice address

204 S Harvard Ave
Arlington Heights, IL 60005-1646

Phone

(773) 490-6486

NPI assigned

Oct 7, 2019

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: lifestancehealth.lisakusumpa@146897.advancedmd-direct.com

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.

• Illinois Geriatric Psychological Services P.C.

  • Clinical Psychologist
  • Harvard, IL
  • NPI 1184999310
  NPD (past)

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

{
    "created_epoch": "1570406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596499200000",
    "number": "1306487798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5017 W BERTEAU AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606411738",
            "telephone_number": "773-490-6486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 S HARVARD AVE",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600051646",
            "telephone_number": "773-490-6486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUSUMPA",
        "first_name": "LISA",
        "name_prefix": "Mrs.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-07",
        "last_updated": "2020-08-04",
        "certification_date": "2020-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149010909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meghana Kunduru, MD
• Noam Kupfer
• Mitchell Kupferberg, MSW, LCSW
• Anjaly Kurian, PHARMD
• Dorota Kus, PT
• Joseph L Kut, MD
• John Kuzelka
• Meg Michelle Kwak, PHD
• Kyu Chiropractic/Acupuncture
• Justyna E Labowicz

• Clinical Social Worker in Arlington Heights, IL
• Providers in Arlington Heights, 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 Aug 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.

Verify at the official NPI Registry.