Individual provider Active NPI

Pamela Joan Kneisel, PHD

  • Clinical Psychologist
  • Hanover, VT
National Provider Identifier
1063549244
Registry record updated Feb 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
388 Issued in NH
Practice address
53 S Main St
Hanover, VT 05075
Phone
(603) 643-5253
NPI assigned
Feb 27, 2007
Last updated
Feb 23, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 23, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 388 NH Primary
Clinical Psychologist 103TC0700X 587 VT

Addresses

Primary practice location

53 S Main St
Hanover, VT 05075

Mailing address

53 S. Main St.
Hanover, VT 05075
Phone (603) 643-5253

Other identifiers 1

IdentifierTypeStateIssuer
0608036YONH01OtherNHANTHEM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH, VT2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20051012000908 NH Practitioner - Clinical Psychologist 6305861980 Practice locations: Hanover, NH
I20210726002859 VT Practitioner - Clinical Psychologist 6305861980 Practice locations: Norwich, VT

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

289 Main St
Norwich, VT 05055-9351
Phone (802) 649-5400

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
587VTMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Festina Lente, PLLC PastSince Nov 17, 2022 Accepting new patients

Organizations & group practices 1

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": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456185600000",
    "number": "1063549244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53 S. MAIN ST.",
            "city": "HANOVER",
            "state": "VT",
            "postal_code": "05075",
            "telephone_number": "603-643-5253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 S MAIN ST",
            "city": "HANOVER",
            "state": "VT",
            "postal_code": "05075",
            "telephone_number": "603-643-5253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNEISEL",
        "first_name": "PAMELA",
        "middle_name": "JOAN",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-27",
        "last_updated": "2016-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NH",
            "license": "388",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VT",
            "license": "587",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "0608036YONH01",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Sources for this page

Verify at the official NPI Registry.