Active NPI
Taryn Nicole Lisa
- Mental Health Counselor
- Monroe, NY
National Provider Identifier
1245053180
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 015291
- Practice address
- 360 State Route 17M Ste 4
Monroe, NY 10950-3444 - Phone
- (845) 547-0479
- NPI assigned
- Nov 7, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 015291 | NY | Primary |
Addresses
Primary practice location
360 State Route 17M Ste 4
Monroe, NY 10950-3444
Mailing address
360 State Route 17M Ste 4
Monroe, NY 10950-3444
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 015291 | NY | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jessica C. Sullivan LCSW, PLLC | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1730937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730937600000",
"number": "1245053180",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "360 STATE ROUTE 17M STE 4",
"city": "MONROE",
"state": "NY",
"postal_code": "109503444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "360 STATE ROUTE 17M STE 4",
"city": "MONROE",
"state": "NY",
"postal_code": "109503444",
"telephone_number": "845-547-0479"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LISA",
"first_name": "TARYN",
"middle_name": "NICOLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-11-07",
"last_updated": "2024-11-07",
"certification_date": "2024-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "015291",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monroe, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.