Active NPI
Lisa Marie Dandurand Fitzpatrick, PSY.D.
- Clinical Psychologist
- Wrentham, MA
National Provider Identifier
1508358433
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 8414
- Practice address
- 90 Martin LN
Wrentham, MA 02093-1070 - Phone
- (508) 667-1932
- NPI assigned
- Jun 6, 2018
- Last updated
- Feb 18, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 4390 | NC | |
| Clinical Psychologist | 103TC0700X | 8414 | MA | Primary |
Addresses
Primary practice location
90 Martin LN
Wrentham, MA 02093-1070
Mailing address
390 West St Ste 3
Mansfield, MA 02048-1170
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 20, 2024 through Feb 20, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4390 | NC | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708214400000",
"number": "1508358433",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "390 WEST ST STE 3",
"city": "MANSFIELD",
"state": "MA",
"postal_code": "020481170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "90 MARTIN LN",
"city": "WRENTHAM",
"state": "MA",
"postal_code": "020931070",
"telephone_number": "508-667-1932"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FITZPATRICK",
"first_name": "LISA",
"middle_name": "MARIE DANDURAND",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-06-06",
"last_updated": "2024-02-18",
"certification_date": "2024-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "4390",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "8414",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wrentham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.