Lisa L Nicholson, LICSW

Primary specialty

PsychologistTaxonomy code 103T00000X

License

089-0000699 Issued in VT

Practice address

29 Elm St
Brattleboro, VT 05301-6511

Phone

(802) 254-7511

Fax

(802) 254-7506

NPI assigned

Mar 26, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in VT

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Health Care and Rehabilitation Services of Southeastern Vermont, Inc.

  • Community/Behavioral Health Agency
  • Springfield, VT
  • NPI 1790861342
  Medicare reassignment NPD
• Health Care and Rehabilitation Services of Southeastern Vermont, Inc.

  • Community/Behavioral Health Agency
  • Bellows Falls, VT
  • NPI 1396962742
  NPD

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114045671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HOSPITAL CT",
            "address_2": "STE 410",
            "city": "BELLOWS FALLS",
            "state": "VT",
            "postal_code": "051011489",
            "telephone_number": "802-463-3294",
            "fax_number": "802-463-1206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 ELM ST",
            "city": "BRATTLEBORO",
            "state": "VT",
            "postal_code": "053016511",
            "telephone_number": "802-254-7511",
            "fax_number": "802-254-7506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "LISA",
        "middle_name": "L",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "VT",
            "license": "089-0000699",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OVN2757",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2158213",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "49345",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert D Nassau, MD
• Naturae Medical
• Barry P Nelson, PSYCHOLOGIST - MA
• David R Neumeister, DDS
• Clyde Alfred Newton, MD
• Robert E Nield, MSW LCSW LICSW
• Sarah Daoust Nohl, PH.D.
• Hannah Cressy North, CNM
• Leah Nussbaum, RN, IBCLC
• Mary Ann O'Beirne, PA

• Psychologist in Brattleboro, VT
• Providers in Brattleboro, VT by specialty
• Psychologist in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.