Nancy Lynn Brison-Moll, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY15243 Issued in CA

Practice address

965 E Yosemite Ave Ste 12
Manteca, CA 95336-5944

Phone

(209) 483-4498

Fax

(209) 824-0010

NPI assigned

Sep 21, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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 1

Specialty

Clinical Psychologist

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554336000000",
    "number": "1053410878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "965 E YOSEMITE AVE STE 12",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953365944",
            "telephone_number": "209-483-4498",
            "fax_number": "209-824-0010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "965 E YOSEMITE AVE STE 12",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953365944",
            "telephone_number": "209-483-4498",
            "fax_number": "209-824-0010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRISON-MOLL",
        "first_name": "NANCY",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-21",
        "last_updated": "2019-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 15243",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY15243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5088836",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jamie Bravo Salas
• Blanca A Bravo Valdovinos
• Rhonda M. Brazil, N.P.
• Lorraine Breen
• Kelly Lynn Briggs, RN
• Janna Bernice Brocchini, FNP
• Amber D Brown, SP 17406
• Breana Brown
• Camilla Donette Brown
• Cenarus Laree Brown

• Psychologist in Manteca, CA
• Providers in Manteca, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.