Xander Lodge, Ma, PLC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

XANDER LODGE, MA, PLC

Doing business as

LODGE PSYCHOTHERAPY

Practice address

75 Talcott Rd Ste 30
Williston, VT 05495-8122

Phone

(802) 503-2929

NPI assigned

Sep 19, 2022

Organization subpart

No

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

Authorized official

Name

Alexander Lodge, MANPI 1720700404

Title

Owner

Phone

(802) 503-2929

Specialties & licenses 1

Addresses

Other names 1

• LODGE PSYCHOTHERAPY Doing business as

Medicare fee-for-service enrollment

Enrolled in VT

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alexander Lodge, MA

  • Psychologist
  • Williston, VT
  • NPI 1720700404
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1663545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718582400000",
    "number": "1255053930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 METCALF DR",
            "city": "WILLISTON",
            "state": "VT",
            "postal_code": "054958802",
            "telephone_number": "802-503-2929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 TALCOTT RD STE 30",
            "city": "WILLISTON",
            "state": "VT",
            "postal_code": "054958122",
            "telephone_number": "802-503-2929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "XANDER LODGE, MA, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-19",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A",
        "authorized_official_last_name": "LODGE",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "802-503-2929",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LODGE PSYCHOTHERAPY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LODGE PSYCHOTHERAPY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Darla E Witmer, ARNP
• Ann S Wittpenn, M.D.
• Jason Wolstenholme, D.C.
• Jillian C.O. Womersley, PT
• Sandra Gail Wood, CNM
• Gabrielle Shevon Young, PT, DPT

• Psychologist in Williston, VT
• Providers in Williston, VT by specialty
• Psychologist in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.