Active NPI
Lisa Lynne Autry, M. S.W., A.C.S.W.
- Clinical Social Worker
- Bedford, IN
National Provider Identifier
1760737274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 34003553A
- Practice address
- 2125 16TH Street
Bedford, IN 47421 - Phone
- (812) 275-4053
- NPI assigned
- Jul 20, 2012
- Last updated
- Jul 20, 2012
- 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 | 34003553A | IN | Primary |
Addresses
Primary practice location
2125 16TH Street
Bedford, IN 47421
Mailing address
4001 Rosewood Drive
Bloomington, IN 47404
Phone (812) 929-2747
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34003553A | IN | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hoosier Uplands Economic Development Corporation | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Serenity Now Psychiatric & Counseling Services
- Adult Mental Health Clinic/Center
- Bedford, IN
- NPI 1376813147
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1342742400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1342742400000",
"number": "1760737274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4001 ROSEWOOD DRIVE",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "47404",
"telephone_number": "812-929-2747"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2125 16TH STREET",
"city": "BEDFORD",
"state": "IN",
"postal_code": "47421",
"telephone_number": "812-275-4053"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AUTRY",
"first_name": "LISA",
"middle_name": "LYNNE",
"name_prefix": "Mrs.",
"credential": "M. S.W., A.C.S.W.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-07-20",
"last_updated": "2012-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IN",
"license": "34003553A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bedford, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.