Lisa S Gonzenbach LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0969C Issued in AL

Legal business name

LISA S GONZENBACH LLC

Practice address

3600 Watermelon Rd
Suite 202
Northport, AL 35473-5169

Phone

(205) 750-0181

NPI assigned

Sep 25, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lisa Gonzenbach

Title

Owner

Phone

(205) 750-0181

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1380067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390435200000",
    "number": "1861828519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 WATERMELON RD",
            "address_2": "SUITE 202",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354735169",
            "telephone_number": "205-750-0181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 WATERMELON RD",
            "address_2": "SUITE 202",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354735169",
            "telephone_number": "205-750-0181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISA S GONZENBACH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-25",
        "last_updated": "2014-01-23",
        "status": "A",
        "authorized_official_last_name": "GONZENBACH",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "205-750-0181"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "AL",
            "license": "0969C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.