Lisa Ra, MA, LAC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

37PC00463800 Issued in NJ

Practice address

22-08 Route 208 Ste 16
Fair Lawn, NJ 07410-2609

Phone

(201) 956-6363

Fax

(201) 956-6026

NPI assigned

Sep 28, 2019

Last updated

Sep 28, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wellsprings Counseling Center, LLC

  • Clinical Social Worker
  • Fair Lawn, NJ
  • NPI 1285844050
  NPD

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

{
    "created_epoch": "1569628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569628800000",
    "number": "1538710744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 HARVEY ST",
            "city": "CLOSTER",
            "state": "NJ",
            "postal_code": "076241132",
            "telephone_number": "201-673-0579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22-08 ROUTE 208 STE 16",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074102609",
            "telephone_number": "201-956-6363",
            "fax_number": "201-956-6026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RA",
        "first_name": "LISA",
        "credential": "MA, LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-28",
        "last_updated": "2019-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NJ",
            "license": "37PC00463800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Www.Wellsprings.org",
            "affiliation": "N",
            "address_1": "22-08 Route 208 Ste 16",
            "city": "Fair Lawn",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "074102609",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Www.Wellsprings.org",
            "affiliation": "N",
            "address_1": "22-08 Route 208 Ste 16",
            "city": "Fair Lawn",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "074102609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Pulmonary Solutions LLC
• Rene Justin Punsal, NP
• Purebody Wellness
• Andi Qipo, M.D.
• Judy U Quizon, P.T.
• Douglas S Rabin, MD
• Edward Ira Radel, M.D.
• Colleen Mary Rademaker
• Natalia Raeva, OD
• Raf LLC (Brightstar Healthcare)

• Professional Counselor in Fair Lawn, NJ
• Providers in Fair Lawn, NJ by specialty
• Professional Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2019; 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.