Jason Bennett Lake, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C006990 Issued in NC

Practice address

1100 Logger CT
G-103
Raleigh, NC 27609-8525

Phone

(919) 538-5511

NPI assigned

Feb 9, 2011

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1297209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392595200000",
    "number": "1922304948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 LOGGER CT STE G103",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276098512",
            "telephone_number": "919-538-5511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 LOGGER CT",
            "address_2": "G-103",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276098525",
            "telephone_number": "919-538-5511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "JASON",
        "middle_name": "BENNETT",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-02-09",
        "last_updated": "2014-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C006990",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "C006990",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susanna S Lai, M.D.
• Karen M Lainez Rubi, RD, LDN, CHES
• Caitlin Laird
• Adam John Lake, M.D.
• Allison Lake
• Lynn Elizabeth Lake, OT
• Lakewheeler Road Family Care Home
• James Randall Lakey, M.D.
• Kyla Lakey
• Asim Ahmed Lal, MD

• Clinical Social Worker in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 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.