Jennica Laine-Formisano, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

021267-1 Issued in NY

Practice address

260 Kings Mall CT # 331
Kingston, NY 12401-1574

Phone

(845) 489-3687

NPI assigned

Jan 4, 2013

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

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 and National Provider Directory roles.

• Jennica Laine-Formisano PSYD

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Kingston, NY
  • NPI 1093454159
  NPD Authorized official

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

{
    "created_epoch": "1357257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620345600000",
    "number": "1346587862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 BURT ST",
            "city": "SAUGERTIES",
            "state": "NY",
            "postal_code": "124771907",
            "telephone_number": "845-489-3687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 KINGS MALL CT # 331",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124011574",
            "telephone_number": "845-489-3687"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20 Milton Ave",
            "address_purpose": "LOCATION",
            "city": "Highland",
            "state": "NY",
            "postal_code": "125281415",
            "country_code": "US",
            "telephone_number": "845-489-3687",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "148 Burt St",
            "address_purpose": "LOCATION",
            "city": "Saugerties",
            "state": "NY",
            "postal_code": "124771907",
            "country_code": "US",
            "telephone_number": "845-489-3687",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAINE-FORMISANO",
        "first_name": "JENNICA",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-04",
        "last_updated": "2021-05-07",
        "certification_date": "2021-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "021267-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laurie Elizabeth Kyle-Budenholzer, LMHC
• Jennifer Lacina, FNP
• Ellis W Lader, M.D.
• Natalie Lagnese
• Colleen Laico, FNP
• Catherine Lala, NPP
• Patrick Ki-Cheong Lam, MD
• Bridget Michelle Lander, COUNSELOR
• Elizabeth Landsverk, RN
• Therese Elaine Lane, MS., MED

• Clinical Psychologist in Kingston, NY
• Providers in Kingston, 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 May 7, 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.