MS. VICTORIA DE LISSOVOY LCSW
NPI 1639124100
Social Worker - Clinical in Lake Wales, FL

Q: What is Victoria De Lissovoy's NPI number?

The NPI number for Victoria De Lissovoy is 1639124100. It was assigned to this individual provider in the NPPES registry on May 23, 2006.

Q: What is Victoria De Lissovoy's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Active since May 23, 2006PECOS Enrolled

1109 BRYN MAWR AVE, LAKE WALES, FL 33853(863) 605-1865 Get Directions Write a Review

NPPES record last updated: June 4, 2008. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Ms. Victoria De Lissovoy Lcsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. VICTORIA DE LISSOVOY LCSW (NPI 1639124100) is an individual clinical provider in Lake Wales, Florida, licensed in Florida (SW6807) and active in the NPI registry since May 2006. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1639124100

Entity TypeIndividualFemale

Primary Taxonomy1041C0700X

Provider Legal NameMS. VICTORIA DE LISSOVOYCredential: LCSW

Location Address1109 BRYN MAWR AVELake Wales, FL 33853-4333

Mailing Address6253 N Lantana Dr, Po Box 7037Indian Lake Estates, FL 33855-7037 · (863) 605-1865

Phone(863) 605-1865

Sole ProprietorYes

Enumeration DateMay 23, 2006

Last NPPES UpdateJune 4, 2008

✔ NPI 1639124100 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code1041C0700X

License✔ Licensed in FL · SW6807

Definition

A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

1109 BRYN MAWR AVE, Lake Wales, FL 33853

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company), Oscar Health Maintenance Organization of Florida.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ms. Victoria De Lissovoy Lcsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Victoria De Lissovoy reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Mtca Psychological Services P.A.

160 mi

Clinical

16853 NE 2ND AVE STE 304
North Miami Beach, FL 33162

Reassigned Medicare billing, Florida enrollment
148 clinicians in this Medicare group

NPI 1740552322 (786) 414-6666

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 33853 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$0.00 typical visit price

range $56.00 – $171.84

Typical copayment $0.00 (range $14.00 – $42.96)

Most-billed visit code NA

Established Patient

$70.04 typical visit price

range $17.57 – $139.16

Typical copayment $17.51 (range $4.39 – $34.79)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. JODIE DEMAY SCHMIDT ARNP-C

Nurse Practitioner