Phoenix Psychotherapy LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2051 Issued in CO

Legal business name

PHOENIX PSYCHOTHERAPY LLC

Practice address

595 Dorset St Ste 2
South Burlington, VT 05403-6240

Phone

(802) 651-8999

Fax

(802) 651-8997

NPI assigned

Dec 18, 2013

Organization subpart

No

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

Authorized official

Name

Judith Vanderryn, PH.D.NPI 1760587323

Title

Owner/Sole Proprietor

Phone

(802) 651-8999

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VT

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Judith Vanderryn, PH.D.

  • Clinical Psychologist
  • South Burlington, VT
  • NPI 1760587323
  Medicare reassignment Authorized official
• Christina Allen, LICSW

  • Clinical Social Worker
  • South Burlington, VT
  • NPI 1740336924
  NPD
• Tammie Anne Consejo, LCMHC

  • Mental Health Counselor
  • South Burlington, VT
  • NPI 1215243597
  NPD (past)
• Raquel Ferns Lefebvre

  • Psychologist
  • Williston, VT
  • NPI 1104004274
  NPD (past)
• Jessica A Young, LICSW

  • Clinical Social Worker
  • Shelburne, VT
  • NPI 1215902150
  NPD (past)

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

{
    "created_epoch": "1387324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702857600000",
    "number": "1114348166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 125",
            "city": "VERGENNES",
            "state": "VT",
            "postal_code": "054910125",
            "telephone_number": "802-651-8999",
            "fax_number": "802-651-8997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 DORSET ST STE 2",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054036240",
            "telephone_number": "802-651-8999",
            "fax_number": "802-651-8997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX PSYCHOTHERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-18",
        "last_updated": "2023-12-18",
        "certification_date": "2023-12-18",
        "status": "A",
        "authorized_official_last_name": "VANDERRYN",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_title_or_position": "OWNER/SOLE PROPRIETOR",
        "authorized_official_telephone_number": "802-651-8999",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "CO",
            "license": "2051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1760587323",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janis Mussett Peyser, PHD
• Philip Lynn Pezeshki
• Nancy Phelan, P.T.
• Michael Phillips, PA
• Phoenix Physical Therapy PLLC
• Physialign LLC
• Physical Therapy Center of Vermont LLC
• Bethany Juscen Pike, CMT
• Pillsbury Associates, Inc
• Christianna M Pilsucki, LICSW

• Psychologist in South Burlington, VT
• Providers in South Burlington, VT by specialty
• Psychologist in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.