Mark J Detzer, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

854 Issued in NH

Practice address

85 N Main St
Suite 200
White River Junction, VT 05001-7134

Phone

(802) 299-6498

Fax

(888) 972-1623

NPI assigned

Sep 14, 2006

Last updated

Oct 4, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Clinical Psychologist

Education

University of Vermont College of Medicine, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Northeastern Vermont Regional Hospital IncGroup PAC ID 3678481405, 104 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Northeastern Vermont Regional Hospital Inc

  dba NVRH Mental Health Group

  • Specialist
  • St Johnsbury, VT
  • NPI 1760773774
  Medicare reassignment Care Compare group NPD
• Northeastern Vermont Regional Hospital Inc.

  dba NVRH Podiatry Clinic

  • Podiatrist
  • St Johnsbury, VT
  • NPI 1710631635
  NPD
• Northeastern Vermont Regional Hospital, Inc

  dba NVRH Cardiology Group

  • Critical Access Hospital
  • St Johnsbury, VT
  • NPI 1013430511
  NPD
• Northeastern Vermont Regional Hospital, Inc

  dba NVRH Orthopedic Group

  • Critical Access Hospital
  • St Johnsbury, VT
  • NPI 1326081811
  NPD
• Northeastern Vermont Regional Hospital, Inc

  dba NVRH Neurology Clinic

  • Critical Access Hospital
  • St Johnsbury, VT
  • NPI 1548202690
  NPD

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380844800000",
    "number": "1215032214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 712",
            "city": "WHITE RIVER JUNCTION",
            "state": "VT",
            "postal_code": "050010712",
            "telephone_number": "802-299-6498",
            "fax_number": "888-972-1623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 N MAIN ST",
            "address_2": "SUITE 200",
            "city": "WHITE RIVER JUNCTION",
            "state": "VT",
            "postal_code": "050017134",
            "telephone_number": "802-299-6498",
            "fax_number": "888-972-1623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETZER",
        "first_name": "MARK",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2013-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NH",
            "license": "854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine E Demers, LMFT
• Lindsay Ann Demuth, PSY.D.
• Department of Veteran Affairs
• Department of Veterans Affairs
• Department of Veterans Affairs
• Peter LM Deutsch
• Kathryn Dezotell, BS MSW
• Amanda Digeorge, APRN
• Emily Helen Dillon, DNP, FNP-C
• Jennifer Donahue

• Clinical Psychologist in White River Junction, VT
• Providers in White River Junction, VT by specialty
• Clinical Psychologist in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2013; 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.

Verify at the official NPI Registry.