Lisa Burgos, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW19016 Issued in FL

Practice address

1835 Gilmore Ave
Lakeland, FL 33805-3017

Phone

(863) 519-0575

NPI assigned

Apr 27, 2017

Last updated

Feb 14, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

A Time to Change Counseling CenterGroup PAC ID 5890048250, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• A Time to Change Counseling Center

  • Clinical Social Worker
  • Crawfordville, FL
  • NPI 1306079587
  Medicare reassignment Care Compare group NPD
• A Time to Change Counseling Center

  • Mental Health Counselor
  • Tallahassee, FL
  • NPI 1932940632
  NPD (past)
• Peace River Center for Personal Development Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lakeland, FL
  • NPI 1538802939
  NPD (past)

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

{
    "created_epoch": "1493251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644796800000",
    "number": "1871028829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1559",
            "city": "BARTOW",
            "state": "FL",
            "postal_code": "338311559",
            "telephone_number": "863-519-0575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1835 GILMORE AVE",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338053017",
            "telephone_number": "863-519-0575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGOS",
        "first_name": "LISA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-27",
        "last_updated": "2022-02-14",
        "certification_date": "2022-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW19016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112356300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole Maido Bunac
• Christopher Bunk, PHARMD
• Bette Burch, RPH
• Daisha Burgess, APRN
• Jennifer Berrios Burgos, MA, CAS
• Diana A Burgueno Vega, M.D.
• Jorge Enrique Burgueno, MD
• Heather Burke, RBT
• Lynnette Burke
• Shane M Burke, MD, MBA

• Clinical Social Worker in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 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.