Individual provider Active NPI

Lisa J Moon, LCSW

  • Clinical Social Worker
  • New London, CT
National Provider Identifier
1427112390
Registry record updated Nov 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
8680 Issued in CT
Practice address
21 Montauk Ave
New London, CT 06320-4906
Phone
(860) 271-4715
NPI assigned
Dec 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2021

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 8680 CT Primary

Addresses

Primary practice location

21 Montauk Ave
New London, CT 06320-4906

Mailing address

PO Box 390
New London, CT 06320-0390
Phone (860) 271-4715

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20140826000249 CT Practitioner - Clinical Social Worker 4587741012 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8680CTMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Sound Community Services, Inc. CurrentSince Feb 1, 2018 Accepting new patients
Urologic Associates, PC PastSince Feb 1, 2018 Accepting new patients
Aroga Medical Associates, PC PastSince Apr 1, 2012 Accepting new patients

Locations

21 Montauk Ave
New London, CT 06320
Phone (860) 439-6400

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/soundcommunityservices/r4/

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": "1166659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636329600000",
    "number": "1427112390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 390",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063200390",
            "telephone_number": "860-271-4715",
            "fax_number": "860-333-1390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 MONTAUK AVE",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204906",
            "telephone_number": "860-271-4715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "LISA",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-21",
        "last_updated": "2021-11-08",
        "certification_date": "2021-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "8680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New London, CT

Sources for this page

Verify at the official NPI Registry.