Individual provider Active NPI

Lisa Marie Petroske

  • Clinical Social Worker
  • Easton, MD
National Provider Identifier
1356962997
Registry record updated May 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
300 Talbot St
Easton, MD 21601-3525
Phone
(410) 822-1018
Fax
(410) 820-5884
NPI assigned
May 6, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2020

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 Primary

Addresses

Primary practice location

300 Talbot St
Easton, MD 21601-3525

Mailing address

300 Talbot St
Easton, MD 21601-3525
Phone (410) 822-1018

Other names 1

  • Lisa Marie Wilson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20221017002488 MD Practitioner - Clinical Social Worker 8325414360 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
For All Seasons, Inc.Group PAC ID 0244214187, 17 clinicians

Practice addresses (Care Compare)

300 Talbot St
Easton, MD 21601-3525
Phone (410) 822-1018

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
For All Seasons, Inc Clinical CurrentSince Sep 22, 2022 Accepting new patients
For All Seasons, Inc. Clinical PastSince Jul 25, 2019 Accepting new patients
For All Seasons, Inc. Clinical Past Accepting new patients

Locations

208 Cedar St
Cambridge, MD 21613
Phone (410) 476-4441

8221 Teal Dr
Ste 427
Easton, MD 21601

300 Talbot St
Easton, MD 21601

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": "1588723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588723200000",
    "number": "1356962997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 TALBOT ST",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216013525",
            "telephone_number": "410-822-1018",
            "fax_number": "410-820-5884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 TALBOT ST",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216013525",
            "telephone_number": "410-822-1018",
            "fax_number": "410-820-5884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROSKE",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-06",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "WILSON",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Easton, MD

Sources for this page

Verify at the official NPI Registry.