NPIMap

Organization Active NPI

Psybridge, LLC

Doing business as Psychological Wellness Center

  • Clinical Psychologist
  • Lake Worth, FL
National Provider Identifier
1356876122
Registry record updated Apr 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY8639 Issued in FL
Legal business name
PSYBRIDGE, LLC
Doing business as
Psychological Wellness Center
Practice address
8401 Lake Worth Rd
Lake Worth, FL 33467-2400
Phone
(561) 207-7625
NPI assigned
Apr 28, 2017
Last updated
Apr 28, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2017

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

Authorized official

Name
Stephanie Lippman, PSY.D.NPI 1407283948
Title
President
Phone
(813) 323-0636

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PY8639 FL Primary

Addresses

Primary practice location

8401 Lake Worth Rd
Lake Worth, FL 33467-2400

Mailing address

8401 Lake Worth Rd
Lake Worth, FL 33467-2400
Phone (561) 207-7625

Other names 1

  • Psychological Wellness Center Doing business as

National Provider Directory

National Provider Directory

Locations

8401 Lake Worth Rd
Lake Worth, FL 33467
Phone (561) 207-7625

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1493337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493337600000",
    "number": "1356876122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8401 LAKE WORTH RD",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334672400",
            "telephone_number": "561-207-7625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8401 LAKE WORTH RD",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334672400",
            "telephone_number": "561-207-7625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYBRIDGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-28",
        "last_updated": "2017-04-28",
        "status": "A",
        "authorized_official_last_name": "LIPPMAN",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-323-0636",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY8639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Psychological Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Worth, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2017; 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.