Amber Lee Fasula, PSY.D., BCN

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY9333 Issued in FL

Practice address

253 N Orlando Ave Ste 202
Maitland, FL 32751

Phone

(407) 790-4101

Fax

(407) 277-4400

NPI assigned

Dec 31, 2007

Last updated

Mar 31, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Neurogenesis Center of Florida PLLCGroup PAC ID 9739420365, 6 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Neurogenesis Center of Florida, PLLC

  dba Amber Fasula, Psy.D.

  • Clinical Psychologist
  • Maitland, FL
  • NPI 1922474907
  Medicare reassignment Care Compare group NPD Authorized official
• Miracare Neuro Behavioral Health, PC

  dba Palos Behavioral Health Professionals

  • Psychologist
  • Palos Heights, IL
  • NPI 1649329251
  NPD (past)

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

{
    "created_epoch": "1199059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617148800000",
    "number": "1730364472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "253 N ORLANDO AVE STE 202",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327515521",
            "telephone_number": "407-790-4101",
            "fax_number": "407-277-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "253 N ORLANDO AVE STE 202",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "32751",
            "telephone_number": "407-790-4101",
            "fax_number": "407-277-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FASULA",
        "first_name": "AMBER",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "PSY.D., BCN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-31",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY9333",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071007844",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bria Faison
• Maite Noemi Falcon Diaz, FNP-C
• Family Care Counseling Center of Orlando, Inc
• Emer Ann Farrelly, L.M.T
• Laurie Fashakin, PA
• Patrick C. Fattouch, MD
• Jamie Marie Ellison Federico, M.ED., ED.S., NCC
• Felice Center for Pediatric Rehabilitation - Maitland
• Felice Center for Pediatric Rehabilitation, Inc.
• Maria Ysabel Felipe, MSW

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 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.