Active NPI
Lisa Cousins Tracy, PHD, MSW, LCSW
- Clinical Social Worker
- Berkeley, CA
National Provider Identifier
1720595119
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 64812
- Practice address
- 3120 Telegraph Ave Ste 10
Berkeley, CA 94705-1965 - Phone
- (510) 463-1797
- NPI assigned
- Jan 7, 2018
- 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 | 64812 | CA | Primary |
Addresses
Primary practice location
3120 Telegraph Ave Ste 10
Berkeley, CA 94705-1965
Mailing address
4706 Manila Ave
Oakland, CA 94609-2272
Phone (510) 882-4896
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64812 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1515283200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1515283200000",
"number": "1720595119",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4706 MANILA AVE",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946092272",
"telephone_number": "510-882-4896"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3120 TELEGRAPH AVE STE 10",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947051965",
"telephone_number": "510-463-1797"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRACY",
"first_name": "LISA",
"middle_name": "COUSINS",
"credential": "PHD, MSW, LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-01-07",
"last_updated": "2018-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "64812",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.