Individual provider Active NPI

Nicholas J Petrosino

  • Psychiatry Physician
  • South Burlington, VT
National Provider Identifier
1265056451
Registry record updated Feb 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
LP05015 Issued in RI
Practice address
595 Dorset St
South Burlington, VT 05403-6240
Phone
(802) 489-5552
NPI assigned
Jun 3, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X LP05015 RI Primary

Addresses

Primary practice location

595 Dorset St
South Burlington, VT 05403-6240

Mailing address

595 Dorset St Ste 4
South Burlington, VT 05403-6240
Phone (802) 489-5552

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260626000327 VT Practitioner - Psychiatry 8224455308 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2020
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

595 Dorset St
Suite 4
South Burlington, VT 05403-6240

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1591142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771977600000",
    "number": "1265056451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 DORSET ST STE 4",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054036240",
            "telephone_number": "802-489-5552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 DORSET ST",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054036240",
            "telephone_number": "802-489-5552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROSINO",
        "first_name": "NICHOLAS",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-03",
        "last_updated": "2026-02-25",
        "certification_date": "2026-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "RI",
            "license": "LP05015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Burlington, VT

Sources for this page

Verify at the official NPI Registry.