Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Lisa Sara Polon, PSYD

Individual provider Clinical Psychologist · NPI 1366879967

Lisa Sara Polon, PSYD is a Clinical Psychologist in Santa Rosa, California. Qualified in 1994, 32 years ago. Practices with Providence Medical Foundation, a 1,465-clinician group, accepts Medicare assignment and offers telehealth. Licensed in California.

Years since qualifying
32
Licensed in
CA
In the registry since
2013
What do these letters mean?
PSYD — Doctor of Psychology
A doctoral psychologist trained primarily for clinical practice.

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Practice location Address checks out

3569 Round Barn Cir
Santa Rosa, CA 95403-5781
Phone: (707) 303-3600
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence PSY29914 (CA)

Record details

NPI number1366879967
Entity typeIndividual (Type 1)
GenderFemale
Credentials PSYD
Sole proprietorNo
NPI enumeratedSeptember 27, 2013
Last updated in NPPESMay 29, 2020
Certification dateMay 29, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 1994 (32 years in practice)
Group practice Providence Medical Foundation — 1465 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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