Michael Bruce Lister, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

021193-1 Issued in NY

Practice address

423 E Main St
#2
Endicott, NY 13760-6940

Phone

(607) 754-1101

Fax

(607) 754-1107

NPI assigned

Mar 27, 2012

Sex

Male

Sole proprietor

Yes

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

Enrolled in NY

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, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Davenport Holistic Healing and Wellness LLC

  • Clinical Social Worker
  • Spencer, NY
  • NPI 1699590307
  NPD (past)
• Jerry Duvinsky PHD Licensed Psychologist PC

  • Clinical Psychologist
  • Endicott, NY
  • NPI 1043684681
  NPD (past)

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

{
    "created_epoch": "1332806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439337600000",
    "number": "1215203914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "423 E MAIN ST",
            "address_2": "#3",
            "city": "ENDICOTT",
            "state": "NY",
            "postal_code": "137606940",
            "telephone_number": "607-754-1101",
            "fax_number": "607-754-1107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "423 E MAIN ST",
            "address_2": "#2",
            "city": "ENDICOTT",
            "state": "NY",
            "postal_code": "137606940",
            "telephone_number": "607-754-1101",
            "fax_number": "607-754-1107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISTER",
        "first_name": "MICHAEL",
        "middle_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-03-27",
        "last_updated": "2015-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810004531",
            "primary": false
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "VA",
            "license": "0810004531",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "021193-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Jerome Lee, DDS
• Mary Alice Lesko, RN, BSN
• Kathleen Elizabeth Lewis, DO
• Kimberly Lieber-Diaz
• Jessica Marie Link, PHARMD
• Viacheslav Litvinenko, DDS
• Shuning Liu
• Peter Lofaso, MD
• Alison Lopera
• Kim Rene Love, RN

• Clinical Psychologist in Endicott, NY
• Providers in Endicott, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2015; 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.