Active NPI
Jessica M. Donnelly, M.A.
- Psychologist
- Randolph, VT
National Provider Identifier
1124314125
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 047-0072459
- Practice address
- 2 Summer St
Suite 3
Randolph, VT 05060-1173 - Phone
- (802) 735-2275
- NPI assigned
- Jun 28, 2011
- Last updated
- May 3, 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 047-0072459 | VT | Primary |
Addresses
Primary practice location
2 Summer St
Suite 3
Randolph, VT 05060-1173
Mailing address
2 Summer Street
Randolph, VT 05060-7149
Phone (802) 735-2275
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)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 047-0072459 | VT | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493769600000",
"number": "1124314125",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 SUMMER STREET",
"city": "RANDOLPH",
"state": "VT",
"postal_code": "050607149",
"telephone_number": "802-735-2275"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 SUMMER ST",
"address_2": "SUITE 3",
"city": "RANDOLPH",
"state": "VT",
"postal_code": "050601173",
"telephone_number": "802-735-2275"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DONNELLY",
"first_name": "JESSICA",
"middle_name": "M.",
"name_prefix": "Ms.",
"credential": "M.A.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-06-28",
"last_updated": "2017-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "VT",
"license": "047-0072459",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Randolph, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 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.