Lisa Michelle Wyneken, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW77559 Issued in CA

Practice address

2423 Camino del Rio S Ste 205
San Diego, CA 92108-3735

Phone

(775) 338-0773

Fax

(775) 201-0452

NPI assigned

Mar 19, 2013

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 CA

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

Specialty

Clinical Social Worker

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1363651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666569600000",
    "number": "1801138763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2423 CAMINO DEL RIO S STE 205",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083735",
            "telephone_number": "775-338-0773",
            "fax_number": "775-201-0452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2423 CAMINO DEL RIO S STE 205",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083735",
            "telephone_number": "775-338-0773",
            "fax_number": "775-201-0452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNEKEN",
        "first_name": "LISA",
        "middle_name": "MICHELLE",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-03-19",
        "last_updated": "2022-10-24",
        "certification_date": "2022-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW77559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Joseph Wyer
• Sarah Jean Wyles
• Jake Wylie
• Justin Jay Wylie
• Yu Yun Sheng Wyman
• David D Wynn, D.D.S.
• John Nelson Wynn III
• Monique Wynn
• Eileen T. Wynne, DO
• Howard E Wynne, M.D.

• Clinical Social Worker in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2022; 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.

Verify at the official NPI Registry.