Lissette Carmona-Roman, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY11323 Issued in FL

Practice address

521 Brunswick Dr
Davenport, FL 33837-4609

Phone

(347) 480-6490

NPI assigned

Apr 14, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Lissette Carmona Camacho Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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": "1271203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668384000000",
    "number": "1861718975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 BRUNSWICK DR",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338374609",
            "telephone_number": "347-480-6490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 BRUNSWICK DR",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338374609",
            "telephone_number": "347-480-6490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARMONA-ROMAN",
        "first_name": "LISSETTE",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-14",
        "last_updated": "2022-11-14",
        "certification_date": "2022-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PR",
            "license": "3509",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY11323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISSETTE",
            "last_name": "CARMONA CAMACHO",
            "credential": "LISSETTE CARMONA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Psychologist in Davenport, FL
• Providers in Davenport, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.