Lisa M Pezzulich, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

048-0000729 Issued in VT

Practice address

160 Benmont Ave
Suite 20
Bennington, VT 05201-1873

Phone

(802) 442-3520

Fax

(802) 447-3392

NPI assigned

Oct 1, 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 1

Medicare fee-for-service enrollment

Enrolled in VT

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, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mindful Solutions PLLCGroup PAC ID 0749472967, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Mindful Solutions PLLC

  • Clinical Psychologist
  • Bennington, VT
  • NPI 1740501071
  Medicare reassignment Care Compare group Authorized official

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

{
    "created_epoch": "1159660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279756800000",
    "number": "1417040767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 BENMONT AVE",
            "address_2": "SUITE 20",
            "city": "BENNINGTON",
            "state": "VT",
            "postal_code": "052011873",
            "telephone_number": "802-442-3520",
            "fax_number": "802-447-3392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 BENMONT AVE",
            "address_2": "SUITE 20",
            "city": "BENNINGTON",
            "state": "VT",
            "postal_code": "052011873",
            "telephone_number": "802-442-3520",
            "fax_number": "802-447-3392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEZZULICH",
        "first_name": "LISA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-01",
        "last_updated": "2010-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VT",
            "license": "048-0000729",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OVN1922",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Loren T Peck, DDS
• Kristi Lynn Pepoon, MSW, LADC
• Erin Perreault
• Daniel E Perregaux, MD
• Denise Ann Peterson, PH.D., LCMHC-VT
• Robert Anthony Pezzulich, MD
• Pharmacy Inc
• Pharmacy Inc
• Joseph M. Phillips, RT(N), CNMT
• Kelsey Lange Pierce, PA-C

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2010; 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.