Active NPI
Lisa Molluso
- Clinical Social Worker
- Bellport, NY
National Provider Identifier
1669543732
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- R072825
- Practice address
- 16 Station Rd
Suite 7
Bellport, NY 11713-2449 - Phone
- (631) 338-5617
- Fax
- (631) 758-2858
- NPI assigned
- Nov 12, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 | R072825 | NY | Primary |
Addresses
Primary practice location
16 Station Rd
Suite 7
Bellport, NY 11713-2449
Mailing address
PO Box 131
Patchogue, NY 11772-0131
Phone (631) 338-5617
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- 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 |
|---|---|---|---|---|
| I20080529000133 | NY | Practitioner - Clinical Social Worker | 7315017696 | Practice locations: Bellport, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
112 S Country Rd
Suite 207
Bellport, NY 11713-2534
Phone (631) 803-0354
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R072825 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1342137600000",
"number": "1669543732",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 131",
"city": "PATCHOGUE",
"state": "NY",
"postal_code": "117720131",
"telephone_number": "631-338-5617",
"fax_number": "631-758-2858"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16 STATION RD",
"address_2": "SUITE 7",
"city": "BELLPORT",
"state": "NY",
"postal_code": "117132449",
"telephone_number": "631-338-5617",
"fax_number": "631-758-2858"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOLLUSO",
"first_name": "LISA",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-12",
"last_updated": "2012-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "R072825",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bellport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2012; 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.