Lisle Kingery, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

017973 Issued in NY

Practice address

617 Castle St
Geneva, NY 14456-1403

Phone

(315) 521-6100

NPI assigned

Sep 11, 2024

Sex

Male

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 NY

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

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1726012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726012800000",
    "number": "1750117248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 CASTLE ST",
            "city": "GENEVA",
            "state": "NY",
            "postal_code": "144561403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 CASTLE ST",
            "city": "GENEVA",
            "state": "NY",
            "postal_code": "144561403",
            "telephone_number": "315-521-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINGERY",
        "first_name": "LISLE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-09-11",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "017973",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua D. Kerlan, D.P.T.
• Matthew Killips, PHARM.D
• Carrie Kime
• Olivia Rose Kime, LCAT, ATR
• Julie E Kingery, PH.D.
• Kathleen Ann Kirker, NP
• Frederick William Klee, DDS
• Mackenzie Marie Klee
• Nicole Klimt, M.D.
• Wendy Kathleen Kloczkowski - Panetta, OTRL

• Clinical Psychologist in Geneva, NY
• Providers in Geneva, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; 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.