Active NPI
Emily Mazzulla, PH.D.
- Clinical Psychologist
- Burlington, VT
National Provider Identifier
1043689607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0480112979
- Practice address
- 2 Colchester Ave
Burlington, VT 05405-1764 - Phone
- (802) 656-2661
- Fax
- (802) 656-3485
- NPI assigned
- Sep 24, 2015
- Last updated
- Feb 27, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 Psychologist | 103TC0700X | 0480112979 | VT | Primary |
Addresses
Primary practice location
2 Colchester Ave
Burlington, VT 05405-1764
Mailing address
2 Colchester Ave
Burlington, VT 05405-1764
Phone (802) 656-2661
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0480112979 | VT | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1443052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1488153600000",
"number": "1043689607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 COLCHESTER AVE",
"city": "BURLINGTON",
"state": "VT",
"postal_code": "054051764",
"telephone_number": "802-656-2661",
"fax_number": "802-656-3485"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 COLCHESTER AVE",
"city": "BURLINGTON",
"state": "VT",
"postal_code": "054051764",
"telephone_number": "802-656-2661",
"fax_number": "802-656-3485"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAZZULLA",
"first_name": "EMILY",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-09-24",
"last_updated": "2017-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VT",
"license": "0480112979",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burlington, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.