LISA M MANDERINO – Clinical Neuropsychologist, NPI 1790288066
Clinical Neuropsychologist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
253 CLINICAL PSYCHOLOGIST in KY
Provider Addresses for LISA M MANDERINO
3615 NEWBURG RD
LOUISVILLE, KY 402183368
Phone: (502) 909-0772
Fax: (855) 859-0123
Type: Location
Rhodes Road, Kent, Franklin Township, Portage County, Ohio, 44240, United States
KENT, OH 442408100
Phone: (330) 673-1347
Fax: (330) 678-3677
Type: Mailing
3922, Lovers Lane, Ravenna Township, Portage County, Ohio, 44266, United States
RAVENNA, OH 442664200
Phone: (330) 673-1347
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2022-12-12
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20221212001737 | I | Clinical Psychologist | KY | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 40218)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Clinical Psychologist | KY | |
| Clinical Psychologist | OH | |
| Nurse Practitioner | KY | |
| Physician Assistant | KY | |
| Physical Therapist In Private Practice | KY | |
| Physical Therapist In Private Practice | TN | |
| Orthopedic Surgery | KY | |
| Physician Assistant | KY | |
| Clinical Psychologist | KY | |
| Physician Assistant | KY |
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