Lisa Carol T Davenport, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY7447 Issued in FL

Practice address

17100 Royal Palm Boulevard
Suite One
Weston, FL 33326

Phone

(954) 217-2444

Fax

(954) 217-9292

NPI assigned

Mar 5, 2007

Sex

Female

Sole proprietor

No

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

Enrolled in FL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2003

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Mindful Psychology and Wellness Center, Inc

  • Clinical Psychologist
  • Pembroke Pines, FL
  • NPI 1437822988
  Medicare reassignment NPD

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627603200000",
    "number": "1508995432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1931 NW 150TH AVE STE 116",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330282873",
            "telephone_number": "786-383-1856",
            "fax_number": "786-431-4872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17100 ROYAL PALM BOULEVARD",
            "address_2": "SUITE ONE",
            "city": "WESTON",
            "state": "FL",
            "postal_code": "33326",
            "telephone_number": "954-217-2444",
            "fax_number": "954-217-9292"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1931 NW 150th Ave Ste 116",
            "address_purpose": "LOCATION",
            "city": "Pembroke Pines",
            "state": "FL",
            "postal_code": "330282873",
            "country_code": "US",
            "telephone_number": "786-383-1856",
            "fax_number": "786-431-4872",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVENPORT",
        "first_name": "LISA CAROL",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-05",
        "last_updated": "2021-07-30",
        "certification_date": "2021-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY7447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fariba F Darvish, RPH, PARM.D., CPH
• Ribal Darwish, M.D.
• Darren Dase, P.T.
• Dauris Figueras MD, PA
• Alessandra Daisy Davalos
• David S Forrest OD,PA
• Davidshield Home Care LLC
• Guillermo Davila, M.D.
• Davis Chiropractic and Wellness LLC
• Justin B Davis, DC

• Clinical Psychologist in Weston, FL
• Providers in Weston, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.