LISA M MANDERINO
NPI 1790288066
Clinical Neuropsychologist in Louisville, KY

Q: What is Lisa Manderino's NPI number?

The NPI number for Lisa Manderino is 1790288066. It was assigned to this individual provider in the NPPES registry on March 13, 2018.

Q: What is Lisa Manderino's specialty?

The primary specialty registered for this NPI is Clinical Neuropsychologist with taxonomy code 103G00000X.

Q: When was this NPI record last updated?

The NPPES record for Lisa Manderino was last updated on October 13, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since March 13, 2018PECOS EnrolledAccepts Medicare Assignment

3615 NEWBURG RD, LOUISVILLE, KY 40218(502) 909-0772(855) 859-0123 Get Directions Write a Review

NPPES record last updated: October 13, 2022. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Oct 13, 2022, Jul 18, 2022, Mar 13, 2018 (3 updates tracked since 2018).

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About Lisa M Manderino NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LISA M MANDERINO (NPI 1790288066) is an individual clinical neuropsychologist in Louisville, Kentucky and active in the NPI registry since March 2018. She is enrolled in Medicare PECOS and is a graduate of Other (2020).

NPPES Registry Identity

NPI1790288066

Entity TypeIndividualFemale

Primary Taxonomy103G00000X

Provider Legal NameLISA M MANDERINO

Location Address3615 NEWBURG RDLouisville, KY 40218-3368

Mailing Address3615 Newburg RdLouisville, KY 40218-3368 · (502) 909-0772 · Fax (855) 859-0123

Phone(502) 909-0772

Fax(855) 859-0123

Sole ProprietorNo

Medical School CMSOtherGraduated 2020

Enumeration DateMarch 13, 2018

Last NPPES UpdateOctober 13, 20223 updates tracked since enumeration

NPPES CertifiedOctober 13, 2022

✔ NPI 1790288066 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinical NeuropsychologistBehavioral Health & Social Service Providers

Taxonomy Code103G00000X

Definition

A clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems.

3615 NEWBURG RD, Louisville, KY 40218

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Other Identifiers 1

Other276504KY · State License

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include CareSource.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Lisa M Manderino is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8729457882

PECOS Enrollment IDI20221212001737

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ACUITY REHAB

Physical Therapist