Active NPI
Lisa Beth Fuller, PSY.D.
- Clinical Psychologist
- Miami, FL
National Provider Identifier
1841390333
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY6682
- Practice address
- 2627 NE 203Rd St
Suite 214
Miami, FL 33180-1900 - Phone
- (786) 202-0474
- NPI assigned
- Sep 24, 2006
- Last updated
- Sep 4, 2013
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY6682 | FL | Primary |
Addresses
Primary practice location
2627 NE 203Rd St
Suite 214
Miami, FL 33180-1900
Mailing address
2627 NE 203Rd St
Suite 214
Miami, FL 33180-1900
Phone (786) 202-0474
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY6682 | FL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378252800000",
"number": "1841390333",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2627 NE 203RD ST",
"address_2": "SUITE 214",
"city": "MIAMI",
"state": "FL",
"postal_code": "331801900",
"telephone_number": "786-202-0474"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2627 NE 203RD ST",
"address_2": "SUITE 214",
"city": "MIAMI",
"state": "FL",
"postal_code": "331801900",
"telephone_number": "786-202-0474"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "LISA",
"middle_name": "BETH",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-24",
"last_updated": "2013-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY6682",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Miami, FL
- Full Life Patient Care LLC
- Full Medical Services Corp. (Full Medical Services)
- Full Precision Health PLLC
- Full Spectrum Integrated Educational Support Services, LLC (Full Spectrum)
- Karla Caridad Fuller, COTA/L
- Lynnette Yvette Fuller, LMHC
- Douglas Charles Fullerton
- Natalia Fullerton, MD
- Traniece Yvette Fullwood
- Dianeska Fumero Garcia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.