Lisa Anna Spano, PSY.D., BCBA-D

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-05-2397 Issued in NJ

Practice address

35 Clyde Rd
Suite 101
Somerset, NJ 08873-5033

Phone

(732) 873-1212

NPI assigned

Jan 14, 2009

Reactivated

Jun 10, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Elisabetta Anna Pestrichella Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Behavior Therapy Associates PA

  • Psychologist
  • Somerset, NJ
  • NPI 1639997166

  Behavior Analyst

  NPD (past)

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

{
    "created_epoch": "1231891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1669619573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 GATES PLACE",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "07470",
            "telephone_number": "201-694-4998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 CLYDE RD",
            "address_2": "SUITE 101",
            "city": "SOMERSET",
            "state": "NJ",
            "postal_code": "088735033",
            "telephone_number": "732-873-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPANO",
        "first_name": "LISA",
        "middle_name": "ANNA",
        "name_prefix": "Dr.",
        "credential": "PSY.D., BCBA-D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-01-14",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "deactivation_date": "2011-07-20",
        "reactivation_date": "2021-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "083-957",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NJ",
            "license": "1-05-2397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELISABETTA",
            "last_name": "PESTRICHELLA",
            "middle_name": "ANNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Behavior Analyst in Somerset, NJ
• Providers in Somerset, NJ by specialty
• Behavior Analyst in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.