Active NPI
Andrea Vazzana, PHD
- Clinical Child & Adolescent Psychologist
- New York, NY
National Provider Identifier
1023233467
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 015200
- Practice address
- 577 1St Ave
New York, NY 10016-6404 - Phone
- (212) 263-6567
- NPI assigned
- Apr 13, 2007
- Sex
- Female
- Sole proprietor
- No
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 Child & Adolescent Psychologist | 103TC2200X | 015200 | NY | Primary |
Addresses
Primary practice location
577 1St Ave
New York, NY 10016-6404
Mailing address
577 1St Ave
New York, NY 10016-6404
Phone (212) 263-6567
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260219001124 | NY | Order and Referring Only - Clinical Psychologist | 6507346327 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 015200 | NY | MD | Clinical Child & Adolescent Psychologist |
Networks
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H5989
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023233467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "577 1ST AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100166404",
"telephone_number": "212-263-6567"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "577 1ST AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100166404",
"telephone_number": "212-263-6567"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAZZANA",
"first_name": "ANDREA",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "NY",
"license": "015200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.