Active NPI
Lissa Young, PH.D.
- Health Service Psychologist
- Canton, MA
National Provider Identifier
1770763237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Service Psychologist
- License
- 9714
- Practice address
- 1017 Turnpike St Ste 12C
Canton, MA 02021-2847 - Phone
- (781) 462-1845
- NPI assigned
- Nov 13, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Service Psychologist | 103TH0100X | 9714 | MA | Primary |
Addresses
Primary practice location
1017 Turnpike St Ste 12C
Canton, MA 02021-2847
Mailing address
1017 Turnpike St Ste 12C
Canton, MA 02021-2847
Phone (781) 462-1845
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Oct 23, 2017 through Oct 23, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9714 | MA | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370822400000",
"number": "1770763237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1017 TURNPIKE ST STE 12C",
"city": "CANTON",
"state": "MA",
"postal_code": "020212847",
"telephone_number": "781-462-1845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1017 TURNPIKE ST STE 12C",
"city": "CANTON",
"state": "MA",
"postal_code": "020212847",
"telephone_number": "781-462-1845"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "LISSA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-11-13",
"last_updated": "2013-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TH0100X",
"taxonomy_group": "",
"desc": "Psychologist, Health Service",
"state": "MA",
"license": "9714",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2013; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.