Lisa Ann Blevins, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY 14707 Issued in CA

Practice address

501 Mission St
Suite 102
Santa Cruz, CA 95060-3661

Phone

(408) 655-6219

Fax

(408) 288-9824

NPI assigned

Jun 29, 2007

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 1

Medicare fee-for-service enrollment

Enrolled in CA

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, 1992

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

State licenses

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375401600000",
    "number": "1265639678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "484 E SAN FERNANDO ST",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951123513",
            "telephone_number": "408-794-7592",
            "fax_number": "408-288-9824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 MISSION ST",
            "address_2": "SUITE 102",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950603661",
            "telephone_number": "408-655-6219",
            "fax_number": "408-288-9824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLEVINS",
        "first_name": "LISA",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-29",
        "last_updated": "2013-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 14707",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SAN JOSE CITY EMPLOYEE ID",
            "identifier": "030334",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jordi Blanco, MHRS
• Blasczyk Physical Therapy
• Judy Ann Blasczyk, RPT
• Dagny Blaskovich, LCSW
• Jonathan Bleich
• Susan Jane Blewett, LAC
• Bruce Block, MD
• Hayden Block
• Cassandra Blom
• Linda Cooper Bloom, LCSW

• Clinical Psychologist in Santa Cruz, CA
• Providers in Santa Cruz, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2013; 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.