NPIMap

Organization Active NPI

Comprehensive Psychological and Wellness Center,LLC

  • Prescribing (Medical) Psychologist
  • Forked River, NJ
National Provider Identifier
1821208158
Registry record updated Mar 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prescribing (Medical) PsychologistTaxonomy code 103TP0016X
License
35SI00429000 Issued in NJ
Legal business name
COMPREHENSIVE PSYCHOLOGICAL AND WELLNESS CENTER,LLC
Practice address
424 S Main St
Unit F
Forked River, NJ 08731-4641
Phone
(609) 693-4343
NPI assigned
May 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2010

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

Authorized official

Name
Dr. Lisa Marie Granato, PSY.DNPI 1932142148
Title
Physician
Phone
(609) 693-4343

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prescribing (Medical) PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TP0016X 35SI00429000 NJ Primary

Addresses

Primary practice location

424 S Main St
Unit F
Forked River, NJ 08731-4641

Mailing address

424 S Main St
Unit F
Forked River, NJ 08731-4641
Phone (609) 693-4343

Other identifiers 1

IdentifierTypeStateIssuer
2831657000OtherNJAMERIHEALTH GROUP NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060303000461 NJ Part B Supplier - Clinic/Group Practice 5890701528 Receives reassigned benefits from 6 practitioners
Practice locations: Forked River, NJ

National Provider Directory

National Provider Directory

Locations

1044 Lacey Rd
Forked River, NJ 08731
Phone (609) 312-9109

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269216000000",
    "number": "1821208158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 S MAIN ST",
            "address_2": "UNIT F",
            "city": "FORKED RIVER",
            "state": "NJ",
            "postal_code": "087314641",
            "telephone_number": "609-693-4343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 S MAIN ST",
            "address_2": "UNIT F",
            "city": "FORKED RIVER",
            "state": "NJ",
            "postal_code": "087314641",
            "telephone_number": "609-693-4343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE PSYCHOLOGICAL AND WELLNESS CENTER,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2010-03-22",
        "status": "A",
        "authorized_official_last_name": "GRANATO",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "609-693-4343",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D"
    },
    "taxonomies": [
        {
            "code": "103TP0016X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "NJ",
            "license": "35SI00429000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH GROUP NUMBER",
            "identifier": "2831657000",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Forked River, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.