Christy L Bommarito, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

30538 Issued in TX

Practice address

605 Shadywood LN
Richardson, TX 75080-6906

Phone

(972) 771-2545

Fax

(972) 771-2545

NPI assigned

Oct 24, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Christy L Haberstroh Former name

Medicare fee-for-service enrollment

Enrolled in TX

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, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1104816909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 SHADYWOOD LN",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750806906",
            "telephone_number": "972-771-2545",
            "fax_number": "972-771-2545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 SHADYWOOD LN",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750806906",
            "telephone_number": "972-771-2545",
            "fax_number": "972-771-2545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOMMARITO",
        "first_name": "CHRISTY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-10-24",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "30538",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "0088CY",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "096568301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRISTY",
            "last_name": "HABERSTROH",
            "middle_name": "L",
            "credential": "PHD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lakiesha Bohannon, PA
• Sebrena Bohnsack
• Alieu Bojang, APRN (NP)
• Jimmy Carroll Boley, D.D.S., M.S.
• Jessica Lynn Bollin
• David Gregory Bonnet, M.D.
• Booneville Anesthesia Services LLC
• Patrick Boothe, D.O.
• Boppana Primary Care Clinic, PLLC
• Sita M Boppana, M.D.

• Clinical Psychologist in Richardson, TX
• Providers in Richardson, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; 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.