Lisa Bracamonte, PSY D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

35S100697200 Issued in NJ

Practice address

14 Washington Ave
West Caldwell, NJ 07006-7704

Phone

(862) 926-8476

NPI assigned

Jan 8, 2024

Sex

Female

Sole proprietor

Yes

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 NJ

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Corner Psychological Services LLC

  • Psychologist
  • Livingston, NJ
  • NPI 1932922689
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1704672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704672000000",
    "number": "1548030745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 WASHINGTON AVE",
            "city": "WEST CALDWELL",
            "state": "NJ",
            "postal_code": "070067704",
            "telephone_number": "862-926-8476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 WASHINGTON AVE",
            "city": "WEST CALDWELL",
            "state": "NJ",
            "postal_code": "070067704",
            "telephone_number": "862-926-8476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRACAMONTE",
        "first_name": "LISA",
        "name_prefix": "Dr.",
        "credential": "PSY D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-08",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "NJ",
            "license": "35S100697200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blossom Women'S Care LLC
• Tamara Bogdanova, OTR-L
• Robyn Ann Bognar, MS CCC-SLP
• Gianna Bossone
• Carrie Jane Bott, DPT
• Jill Brown, LCSW
• Danielle Brunello
• Lindsey Burns
• Thomas L. Butler, DMD
• C&G Donkey PP Leak LLC

• Psychologist in West Caldwell, NJ
• Providers in West Caldwell, NJ by specialty
• Psychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.