Caroline Teresa Tisot, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY11425 Issued in FL

Practice address

1421 SE 4TH Ave
Fort Lauderdale, FL 33316-1940

Phone

(954) 766-4955

NPI assigned

Nov 14, 2009

Last updated

May 25, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Institute for Life Renovation, LLC

  • Cognitive & Behavioral Psychologist
  • Fort Lauderdale, FL
  • NPI 1386172351
  NPD
• Growth Opportunity Center

  • Counseling Psychologist
  • Southampton, PA
  • NPI 1649222761
  NPD (past)

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

{
    "created_epoch": "1258156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653436800000",
    "number": "1508193350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 LANGHORNE NEWTOWN RD",
            "city": "LANGHORNE",
            "state": "PA",
            "postal_code": "190471232",
            "telephone_number": "267-756-3007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 SE 4TH AVE",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333161940",
            "telephone_number": "954-766-4955"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "928 Jaymor Rd Ste B-150",
            "address_purpose": "LOCATION",
            "city": "Southampton",
            "state": "PA",
            "postal_code": "189663853",
            "country_code": "US",
            "telephone_number": "215-947-8654",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TISOT",
        "first_name": "CAROLINE",
        "middle_name": "TERESA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-14",
        "last_updated": "2022-05-25",
        "certification_date": "2022-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS016658",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY11425",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.