Individual provider Active NPI

Lisa Jane Rekos, LCSW-C

  • Clinical Social Worker
  • Berlin, MD
National Provider Identifier
1740706183
Registry record updated Apr 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
22929 Issued in MD
Practice address
9958 N Main St
Berlin, MD 21811-1076
Phone
(410) 973-2820
Fax
(410) 973-2843
NPI assigned
Aug 17, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2024

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 22929 MD Primary

Addresses

Primary practice location

9958 N Main St
Berlin, MD 21811-1076

Mailing address

PO Box 1978
Salisbury, MD 21802-1978
Phone (410) 749-1015

Other identifiers 1

IdentifierTypeStateIssuer
119591300MedicaidMD

Other names 1

  • Ms. Lisa Jane Mezzacapo Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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

Enrollment IDStateProvider typePAC IDDetails
I20200127001128 MD Practitioner - Clinical Social Worker 9436584166 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
22929MDMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Three Lower Counties Community Services, Inc. CurrentSince Dec 18, 2019 Accepting new patients
Three Lower Counties Community Services, Inc. CurrentSince Dec 18, 2019 Accepting new patients
Three Lower Counties Community Services Inc Current Accepting new patients

Locations

9958 N Main St
Unit 2
Berlin, MD 21811

9958 N Main St
Berlin, MD 21811
Phone (410) 973-2820

12137 Elm St
Princess Anne, MD 21853
Phone (410) 651-1000

1104 Healthway Dr
Salisbury, MD 21804
Phone (410) 219-1100

1813 Sweetbay Dr
Salisbury, MD 21804
Phone (410) 219-5483

1647 Woodbrooke Dr
Salisbury, MD 21804
Phone (410) 546-2424

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1502928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713744000000",
    "number": "1740706183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1978",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218021978",
            "telephone_number": "410-749-1015",
            "fax_number": "410-749-0654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9958 N MAIN ST",
            "city": "BERLIN",
            "state": "MD",
            "postal_code": "218111076",
            "telephone_number": "410-973-2820",
            "fax_number": "410-973-2843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REKOS",
        "first_name": "LISA",
        "middle_name": "JANE",
        "name_prefix": "Ms.",
        "credential": "LCSW-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-17",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "22929",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119591300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "MEZZACAPO",
            "middle_name": "JANE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Berlin, MD

Sources for this page

Verify at the official NPI Registry.