Individual provider Active NPI

Suzanne M Kresiak, LICSW

  • Clinical Social Worker
  • Pittsfield, MA
National Provider Identifier
1992784276
Registry record updated Nov 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
110156 Issued in MA
Practice address
25 Henry Ave
Pittsfield, MA 01201-6722
Phone
(413) 358-3551
Fax
(413) 961-5455
NPI assigned
Jan 13, 2006
Last updated
Nov 20, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 110156 MA Primary

Addresses

Primary practice location

25 Henry Ave
Pittsfield, MA 01201-6722

Mailing address

1872 N Streamline Dr
Virginia Beach, VA 23454-4434
Phone (413) 358-3551

Other practice location 1

1872 N Streamline Dr
Virginia Beach, VA 23454-4434
Phone (413) 358-3551

Other identifiers 1

IdentifierTypeStateIssuer
P08566OtherMABLUE CROSS BLUE SHIELD

Other names 1

  • Miss Suzanne M Lis Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, VA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20051011000386 MA Practitioner - Clinical Social Worker 1850325481 Reassigns benefits to 1 organization
I20251223000712 VA Practitioner - Clinical Social Worker 1850325481 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1998
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1872 N Streamline Dr
Virginia Beach, VA 23454-4434
Phone (413) 358-3551

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
110156MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Hilltown Community Health Centers, Inc. CurrentSince Apr 5, 2010 Accepting new patients
Hilltown Community Health Centers, Inc. CurrentSince Apr 5, 2010 Accepting new patients

Locations

73 Russell Rd
Huntington, MA 01050
Phone (413) 667-3009

58 Old North Rd
Worthington, MA 01098
Phone (413) 238-5511

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1137110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763596800000",
    "number": "1992784276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1872 N STREAMLINE DR",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234544434",
            "telephone_number": "413-358-3551",
            "fax_number": "413-961-5455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 HENRY AVE",
            "city": "PITTSFIELD",
            "state": "MA",
            "postal_code": "012016722",
            "telephone_number": "413-358-3551",
            "fax_number": "413-961-5455"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1872 N Streamline Dr",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "234544434",
            "country_code": "US",
            "telephone_number": "413-358-3551",
            "fax_number": "413-961-5455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KRESIAK",
        "first_name": "SUZANNE",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-13",
        "last_updated": "2025-11-20",
        "certification_date": "2025-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "110156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "P08566",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUZANNE",
            "last_name": "LIS",
            "middle_name": "M",
            "prefix": "MISS",
            "credential": "LICSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Pittsfield, MA

Sources for this page

Verify at the official NPI Registry.