Active NPI
Lisa Dodge, MA, LLP, CAADC
- Clinical Psychologist
- Novi, MI
National Provider Identifier
1447567458
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6361007904
- Practice address
- 23965 Novi Rd Ste 130
Novi, MI 48375-0204 - Phone
- (248) 946-4664
- NPI assigned
- Sep 13, 2010
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6361007904 | MI | Primary |
Addresses
Primary practice location
23965 Novi Rd Ste 130
Novi, MI 48375-0204
Mailing address
1068 Trailside Blvd
Wixom, MI 48393-1587
Phone (248) 926-0871
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6361007904 | MI | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optum Behavioral Care of Colorado, P.C. | 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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Troy, MI
- NPI 1619734969
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1284336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716422400000",
"number": "1447567458",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1068 TRAILSIDE BLVD",
"city": "WIXOM",
"state": "MI",
"postal_code": "483931587",
"telephone_number": "248-926-0871"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23965 NOVI RD STE 130",
"city": "NOVI",
"state": "MI",
"postal_code": "483750204",
"telephone_number": "248-946-4664"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DODGE",
"first_name": "LISA",
"name_prefix": "Ms.",
"credential": "MA, LLP, CAADC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-13",
"last_updated": "2024-05-23",
"certification_date": "2024-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6361007904",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Novi, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 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.