Lyssa Menard, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071-006487 Issued in IL

Practice address

445 E Ohio St Ste 304
Chicago, IL 60611-4675

Phone

(312) 404-9539

NPI assigned

Oct 24, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Northwestern Memorial Physicians Group

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1538111299
  NPD (past)

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590019200000",
    "number": "1720161300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 W HURON ST APT 2604",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606543866",
            "telephone_number": "312-404-9539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 E OHIO ST STE 304",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606114675",
            "telephone_number": "312-404-9539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENARD",
        "first_name": "LYSSA",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-24",
        "last_updated": "2020-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071-006487",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SSN",
            "identifier": "$$$$$$$$$",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "071-006487",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bianca Ivette Mena, LCSW
• Jennifer Mena
• Katherine Mena
• Katie Lynn Mena, M.D.
• Victor Mena, D.N.
• Shannon Menard, PHARMD
• Niccolo Emanuele Mencacci, MD, PHD
• Sara Menchaca
• Jasmine Mencia
• Maria Menconi, C.P.N.P.

• Clinical Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2020; 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.