MEDICARE: LISA L. MCDONALD LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	34005869A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000641250	OTHER	IN	ANTHEM
3	1083881866	OTHER		CAQH

General Provider Information

NPI Number	:	1083881866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA L. MCDONALD LCSW

Provider Business Mailing Address
First Line	:	4800 N SCOTTSDALE RD STE 2500
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7630
Country	:	US
Telephone Number	:	216-468-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	7300 E INDIANA ST STE 103
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-7448
Country	:	US
Telephone Number	:	216-468-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	10/03/2025

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