Individual provider Active NPI

Lisa M Brice, LCSW

  • Clinical Social Worker
  • Saint Augustine, FL
National Provider Identifier
1548715329
Registry record updated Aug 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW13171 Issued in FL
Practice address
248 Southpark Cir E
Saint Augustine, FL 32086-5137
Phone
(904) 797-5680
NPI assigned
Aug 22, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 22, 2016

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 SW13171 FL Primary

Addresses

Primary practice location

248 Southpark Cir E
Saint Augustine, FL 32086-5137

Mailing address

44 Leaver Dr
Palm Coast, FL 32137-9749
Phone (386) 597-7724

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Mar 24, 2025 through Mar 24, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
SW13171FLMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1471824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471824000000",
    "number": "1548715329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 LEAVER DR",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321379749",
            "telephone_number": "386-597-7724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "248 SOUTHPARK CIR E",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320865137",
            "telephone_number": "904-797-5680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRICE",
        "first_name": "LISA",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-22",
        "last_updated": "2016-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW13171",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Augustine, FL

Sources for this page

Verify at the official NPI Registry.