Victoria De Lissovoy, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW6807 Issued in FL

Practice address

1109 Bryn Mawr Ave
Lake Wales, FL 33853-4333

Phone

(863) 605-1865

NPI assigned

May 23, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Mtca Psychological Services P.a.

  • Clinical Psychologist
  • North Miami Beach, FL
  • NPI 1740552322
  Medicare reassignment NPD

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212537600000",
    "number": "1639124100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6253 N LANTANA DR",
            "address_2": "PO BOX 7037",
            "city": "INDIAN LAKE ESTATES",
            "state": "FL",
            "postal_code": "338557037",
            "telephone_number": "863-605-1865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 BRYN MAWR AVE",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534333",
            "telephone_number": "863-605-1865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LISSOVOY",
        "first_name": "VICTORIA",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-23",
        "last_updated": "2008-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW6807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Darazi
• D Davenport, PSY.D.
• Cessenie Davis
• Elease Davis
• Geydi De la Pax Perez
• Yesenia Dejesus-Suarez, CRNA
• Delta Health Management, Inc
• Nydia Gricelle Deltoro Rivera, MD, WCC. DWC, CWS
• Theresa Sunshine Delvalle, COTA
• Veronica E Diaz

• Clinical Social Worker in Lake Wales, FL
• Providers in Lake Wales, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2008; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.