Individual provider Active NPI

Maya A Marzouk, PHD

  • Health Service Psychologist
  • New Haven, CT
National Provider Identifier
1063167096
Registry record updated Jul 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service PsychologistTaxonomy code 103TH0100X
License
005358 Issued in CT
Practice address
350 George St
New Haven, CT 06511-6617
Phone
(844) 362-9272
NPI assigned
Feb 17, 2022
Last updated
Jul 16, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Psychologist 103TH0100X 005358 CT Primary
Health Service Psychologist 103TH0100X
Student in an Organized Health Care Education/Training Program 390200000X
Clinical Psychologist 103TC0700X PS02271 RI

Addresses

Primary practice location

350 George St
New Haven, CT 06511-6617

Mailing address

693 Watch Point Dr
Cincinnati, OH 45230-3765

Other practice location 1

593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-4471

Other practice location 2

3333 Burnet Ave
Cincinnati, OH 45229-3026
Phone (513) 636-4200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240903001145 RI Practitioner - Clinical Psychologist 1951840057 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PS02271RIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespan Physician Group, Inc. Clinical CurrentSince Oct 6, 2024 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Oct 6, 2024 Accepting new patients
Rhode Island Hospital Clinical CurrentSince Oct 6, 2024 Accepting new patients
Rhode Island Hospital CurrentSince Oct 6, 2024 Accepting new patients
Yale University Past Accepting new patients

Locations

1454 S County Trl
Ste 2100
East Greenwich, RI 02818
Phone (401) 606-2000

1 Hoppin St
Ste 2030
Providence, RI 02903
Phone (401) 444-9887

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

593 Eddy St
Providence, RI 02903

593 Eddy St
Ste 105
Providence, RI 02903
Phone (401) 444-5241

593 Eddy St
Ste 5
Providence, RI 02903
Phone (401) 444-3996

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1645056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784160000000",
    "number": "1063167096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "693 WATCH POINT DR",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452303765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 GEORGE ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065116617",
            "telephone_number": "844-362-9272"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "593 Eddy St",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029034923",
            "country_code": "US",
            "telephone_number": "401-444-4471",
            "fax_number": "401-444-7574",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3333 Burnet Ave",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "452293026",
            "country_code": "US",
            "telephone_number": "513-636-4200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARZOUK",
        "first_name": "MAYA",
        "middle_name": "A",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-17",
        "last_updated": "2026-07-16",
        "certification_date": "2026-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "CT",
            "license": "005358",
            "primary": true
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "RI",
            "license": "PS02271",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

Verify at the official NPI Registry.