Active NPI
Lisa Picciotto, LCSW
- Clinical Social Worker
- Syracuse, NY
National Provider Identifier
1396035879
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- P79526
- Practice address
- 1045 James St
Syracuse, NY 13203-2730 - Phone
- (315) 472-4471
- NPI assigned
- Apr 18, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | P79526 | NY | Primary |
Addresses
Primary practice location
1045 James St
Syracuse, NY 13203-2730
Mailing address
1124 E Genesee St
Syracuse, NY 13210-1912
Phone (315) 436-9245
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 10, 2024 through Apr 10, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 083035 | NY | MD | Social Worker |
| P79526 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1303084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442275200000",
"number": "1396035879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1124 E GENESEE ST",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132101912",
"telephone_number": "315-436-9245"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1045 JAMES ST",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132032730",
"telephone_number": "315-472-4471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PICCIOTTO",
"first_name": "LISA",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-04-18",
"last_updated": "2015-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "P79526",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2015; 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.