NPIMap

Organization Active NPI

Twin State Psychological Services

  • Psychologist
  • Springfield, VT
National Provider Identifier
1356579775
Registry record updated Sep 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
TWIN STATE PSYCHOLOGICAL SERVICES
Practice address
29 Ridgewood Rd
Springfield, VT 05156-3060
Phone
(802) 885-5719
Fax
(802) 885-5720
NPI assigned
Jun 24, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2016

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

Authorized official

Name
Dr. Richard W. Root II, ED.D.NPI 1902823636
Title
Owner
Phone
(802) 885-5719

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

29 Ridgewood Rd
Springfield, VT 05156-3060

Mailing address

PO Box 2003
Springfield, VT 05156-2003
Phone (802) 885-5719

Other identifiers 2

IdentifierTypeStateIssuer
1016751MedicaidVT
3080088MedicaidNH

Other names 1

  • Richard W. Root II dba Twin State Psychological Services Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120611000537 VT Part B Supplier - Clinic/Group Practice 2062676638 Receives reassigned benefits from 1 practitioner
Practice locations: Springfield, VT

National Provider Directory

National Provider Directory

Locations

1 Elm St
Ludlow, VT 05149
Phone (802) 228-8867

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1245801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473724800000",
    "number": "1356579775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2003",
            "city": "SPRINGFIELD",
            "state": "VT",
            "postal_code": "051562003",
            "telephone_number": "802-885-5719",
            "fax_number": "802-885-5720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 RIDGEWOOD RD",
            "city": "SPRINGFIELD",
            "state": "VT",
            "postal_code": "051563060",
            "telephone_number": "802-885-5719",
            "fax_number": "802-885-5720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TWIN STATE PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-24",
        "last_updated": "2016-09-13",
        "status": "A",
        "authorized_official_last_name": "ROOT",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "802-885-5719",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "ED.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1016751",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3080088",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Richard W. Root II dba Twin State Psychological Services",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Springfield, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2016; 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.