Courtney Roler Mauzy IV, BCBA PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

332649 Issued in NY

Practice address

475 Irving Ave
Syracuse, NY 13210-1756

Phone

(315) 464-3555

NPI assigned

Sep 7, 2023

Last updated

Sep 19, 2024By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pediatric Service GroupGroup PAC ID 9931007200, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Pediatric Service Group

  • Pediatrics Physician
  • Syracuse, NY
  • NPI 1770539066
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1694044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726704000000",
    "number": "1366228025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 IRVING AVE",
            "address_2": "SUITE 300",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13210",
            "telephone_number": "315-464-3555",
            "fax_number": "315-464-3551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 IRVING AVE",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101756",
            "telephone_number": "315-464-3555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAUZY",
        "first_name": "COURTNEY",
        "middle_name": "ROLER",
        "name_suffix": "IV",
        "credential": "BCBA PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-07",
        "last_updated": "2024-09-19",
        "certification_date": "2023-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "332649",
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "GA",
            "license": "1-20-44673",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael J Maurer, MSW
• Tracy J Maurer, RDH
• Ava Mauriello
• Marino Odeng Mauro, PA
• Alyssa Maute, MSED
• Laila Abdul Mawari II
• Kylie M Mawn
• Elyssa Hagen Max, RN
• Jillian Maxfield, OTR/L
• Sue Ellen Maxfield, SLP

• Psychologist in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; 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.