Active NPI
Lisa Marie Maitland
- Clinical Social Worker
- Modesto, CA
National Provider Identifier
1992377048
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 70632
- Practice address
- 4120 Dale Rd.
Suite J-8 #102
Modesto, CA 95356 - Phone
- (209) 412-3758
- NPI assigned
- Jul 16, 2021
- 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 | 70632 | CA | Primary |
Addresses
Primary practice location
4120 Dale Rd.
Suite J-8 #102
Modesto, CA 95356
Mailing address
4120 Dale Rd.
Suite J-8 #102
Modesto, CA 95356
Phone (209) 412-3758
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 70632 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626393600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626393600000",
"number": "1992377048",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4120 DALE RD.",
"address_2": "SUITE J-8 #102",
"city": "MODESTO",
"state": "CA",
"postal_code": "95356",
"telephone_number": "209-412-3758"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4120 DALE RD.",
"address_2": "SUITE J-8 #102",
"city": "MODESTO",
"state": "CA",
"postal_code": "95356",
"telephone_number": "209-412-3758"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAITLAND",
"first_name": "LISA MARIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-07-16",
"last_updated": "2021-07-16",
"certification_date": "2021-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "70632",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.