Nicole Issa, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PS01615 Issued in RI

Practice address

382 Thayer St
Providence, RI 02906-1558

Phone

(401) 330-5882

Fax

(401) 226-0137

NPI assigned

Feb 27, 2007

Last updated

Jul 25, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Center for Dynamic and Behavioral Therapy LLC

  dba PVD Psychological Associates

  • Clinical Psychologist
  • Providence, RI
  • NPI 1790207876
  NPD Authorized official

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627171200000",
    "number": "1154458438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S ANGELL ST # 405",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029065206",
            "telephone_number": "401-330-5882",
            "fax_number": "401-663-6628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "382 THAYER ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029061558",
            "telephone_number": "401-330-5882",
            "fax_number": "401-226-0137"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "150 Lloyd Ave # 1",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029061553",
            "country_code": "US",
            "telephone_number": "401-330-5882",
            "fax_number": "401-663-6628",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ISSA",
        "first_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-27",
        "last_updated": "2021-07-25",
        "certification_date": "2021-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "9797",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "021654",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "RI",
            "license": "PS01615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Lynn Irving, PA-C
• Laurie Jean Isabella, CRNA
• Amanda Beth Isenberg, LICSW
• Joseph Isik
• Sadeq K M Islam, MD
• Ito Health
• Sivana Isabel Ivanov, RN
• Erin Ivatts, MSN, AGNP-C
• Korrinne Ivey, WHNP-BC
• Ivy Marwil

• Clinical Psychologist in Providence, RI
• Providers in Providence, RI by specialty
• Clinical Psychologist in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2021; 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.