Karen Marie Fondacaro, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0480000390 Issued in VT

Practice address

2 Colchester Ave
Burlington, VT 05405-1764

Phone

(802) 656-2661

Fax

(802) 656-3485

NPI assigned

May 19, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 9, 2020 through Jan 9, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Vermont Psychological Services: Leitenberg Center for Evidence-Based P

  • Clinical Psychologist
  • Burlington, VT
  • NPI 1598837593
  NPD (past)

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488240000000",
    "number": "1225081243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 COLCHESTER AVE",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054051764",
            "telephone_number": "802-656-2661",
            "fax_number": "802-656-3485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 COLCHESTER AVE",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054051764",
            "telephone_number": "802-656-2661",
            "fax_number": "802-656-3485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONDACARO",
        "first_name": "KAREN",
        "middle_name": "MARIE",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-19",
        "last_updated": "2017-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VT",
            "license": "0480000390",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8721",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1002226",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Florian E Foerg, MD
• Courtney Foley, LCMHC
• Kathryn Foley, LICSW
• Marion Foley, F. N. P.
• Owen Edward Foley, PHARMD
• Sienna Fontaine, LICSW, LADC, MSW
• Elizabeth Ann Forbes, MD
• Phyllis S Forbes, M.S.,CCC-SLP
• Christopher Andrew Ford, M.D.
• Jon Patrick Ford, PA-C

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.