Active NPI
Lisa Renee Bermeo, LCSW
- Clinical Social Worker
- San Rafael, CA
National Provider Identifier
1629205349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 25074
- Practice address
- 99 Montecillo Rd
San Rafael, CA 94903-3308 - Phone
- (415) 444-4251
- NPI assigned
- Jun 20, 2009
- Sex
- Female
- Sole proprietor
- No
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 | 25074 | CA | Primary |
Addresses
Primary practice location
99 Montecillo Rd
San Rafael, CA 94903-3308
Mailing address
6 Baker CT
Petaluma, CA 94952-5520
Phone (707) 228-5368
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140228001344 | CA | Practitioner - Clinical Social Worker | 0446480925 | Practice locations: Petaluma, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
Petaluma, CA 94952
Phone 7072285368707775
6 Baker Court
Petaluma, CA 94952-5520
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25074 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245456000000",
"number": "1629205349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 BAKER CT",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949525520",
"telephone_number": "707-228-5368",
"fax_number": "707-773-1766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "99 MONTECILLO RD",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949033308",
"telephone_number": "415-444-4251"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERMEO",
"first_name": "LISA",
"middle_name": "RENEE",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-06-20",
"last_updated": "2009-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "25074",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.