Jennica Laine-Formisano PSYD

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

JENNICA LAINE-FORMISANO PSYD

Practice address

260 Kings Mall CT # 331
Kingston, NY 12401-1574

Phone

(845) 489-3687

Fax

(845) 332-6041

NPI assigned

May 27, 2022

Last updated

May 27, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jennica Laine-Formisano, PSYDNPI 1346587862

Title

Owner

Phone

(845) 489-3687

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennica Laine-Formisano, PSY.D.

  • Clinical Psychologist
  • Kingston, NY
  • NPI 1346587862
  NPD Authorized official

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

{
    "created_epoch": "1653609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653609600000",
    "number": "1093454159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 KINGS MALL CT # 331",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124011574",
            "telephone_number": "845-489-3687",
            "fax_number": "845-332-6041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 KINGS MALL CT # 331",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124011574",
            "telephone_number": "845-489-3687",
            "fax_number": "845-332-6041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENNICA LAINE-FORMISANO PSYD",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-27",
        "last_updated": "2022-05-27",
        "certification_date": "2022-05-26",
        "status": "A",
        "authorized_official_last_name": "LAINE-FORMISANO",
        "authorized_official_first_name": "JENNICA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "845-489-3687",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Allison, LCSW
• Namratha Jampana
• Alexander - Janums, M.D.
• Lorayne Molly Jarvis, R.N.
• Maureen B. Jeffreys, M.S. CCC-SLP
• Jeanne Deangelis Jennings, LMSW
• Jessica Cingel, Midwife-NP in Psychiatry, P.C. (Kinship Health Kingston)
• Amy Jett, MS/CCC-SLP
• Jewish Family Services of Ulster County
• Jewish Federation of Ulster County

• Mental Health Clinic/Center (Including Community Mental Health Center) in Kingston, NY
• Providers in Kingston, NY by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.