Active NPI
Carolyn Irma Vicchiullo, PSYD
- Psychologist
- Easton, PA
National Provider Identifier
1194798108
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PS015116
- Practice address
- 2030 Lehigh St
Suite 107
Easton, PA 18042 - Phone
- (610) 253-8900
- Fax
- (610) 253-7062
- NPI assigned
- Feb 9, 2006
- 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 | PS015116 | PA | Primary |
Addresses
Primary practice location
2030 Lehigh St
Suite 107
Easton, PA 18042
Mailing address
2725 Upstream Farm Rd
Easton, PA 18040
Phone (610) 248-1797
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03183600 | Other | PA | CBC |
| 262019000 | Other | PA | MAGELLAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110412000057 | PA | Practitioner - Clinical Psychologist | 0042494338 | Practice locations: Easton, PA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
2030 Lehigh St
Suite 107
Easton, PA 18042-3855
Phone (610) 253-8900
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS015116 | PA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712016000000",
"number": "1194798108",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2725 UPSTREAM FARM RD",
"city": "EASTON",
"state": "PA",
"postal_code": "18040",
"telephone_number": "610-248-1797",
"fax_number": "610-253-7062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2030 LEHIGH ST",
"address_2": "SUITE 107",
"city": "EASTON",
"state": "PA",
"postal_code": "18042",
"telephone_number": "610-253-8900",
"fax_number": "610-253-7062"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VICCHIULLO",
"first_name": "CAROLYN",
"middle_name": "IRMA",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-02-09",
"last_updated": "2024-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "PA",
"license": "PS015116",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CBC",
"identifier": "03183600",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "262019000",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Easton, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.