Individual provider Active NPI

Tracy A Loysen, PH.D.

  • Clinical Psychologist
  • Montpelier, VT
National Provider Identifier
1194813527
Registry record updated Jan 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
703 Issued in VT
Practice address
159 State St Ste 205
Montpelier, VT 05602-3301
Phone
(802) 498-8960
NPI assigned
Oct 11, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 703 VT Primary

Addresses

Primary practice location

159 State St Ste 205
Montpelier, VT 05602-3301

Mailing address

2809 North St
Montpelier, VT 05602-4486
Phone (802) 498-8960

Other identifiers 1

IdentifierTypeStateIssuer
1006401MedicaidVT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
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
I20180326002203 VT Practitioner - Clinical Psychologist 1153619887 Practice locations: Montpelier, VT

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

159 State St
Suite 205
Montpelier, VT 05602-3301
Phone (802) 498-8960

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
703VTMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611878400000",
    "number": "1194813527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2809 NORTH ST",
            "city": "MONTPELIER",
            "state": "VT",
            "postal_code": "056024486",
            "telephone_number": "802-498-8960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 STATE ST STE 205",
            "city": "MONTPELIER",
            "state": "VT",
            "postal_code": "056023301",
            "telephone_number": "802-498-8960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOYSEN",
        "first_name": "TRACY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-11",
        "last_updated": "2021-01-29",
        "certification_date": "2021-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VT",
            "license": "703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1006401",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montpelier, VT

Sources for this page

Verify at the official NPI Registry.