Marissa Nicole Petersen-Coleman, PSYD.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

048.0132241 Issued in VT

Practice address

111 Colchester Ave
Burlington, VT 05401

Phone

(802) 847-3634

NPI assigned

Apr 8, 2013

Last updated

Aug 20, 2018By the provider in NPPES

Sex

Female

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 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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mpetersencoleman194375@direct.uvmhealth.org

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.

• University of Vermont Medical Center Inc

  dba Uvm Medical Center

  • Internal Medicine Physician
  • Burlington, VT
  • NPI 1659309615
  Medicare reassignment NPD
• Clinic for Education, Treatment and Prevention of Addiction, Inc.

  • Community/Behavioral Health Agency
  • Norcross, GA
  • NPI 1396885059
  NPD (past)

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

{
    "created_epoch": "1365379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534723200000",
    "number": "1528401759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6020 DAWSON BLVD",
            "address_2": "I",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300931229",
            "telephone_number": "770-662-0249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 COLCHESTER AVE",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "05401",
            "telephone_number": "802-847-3634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN-COLEMAN",
        "first_name": "MARISSA",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "PSYD.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-08",
        "last_updated": "2018-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY003680",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VT",
            "license": "048.0132241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gayle Peruzzi
• Matthew Tomitz Perz, MD
• Elizabeth Schindler Perzanowski, MD
• Robin M Pesci, LICSW
• Rebecca Peters, DO
• Christopher Petersen
• Gordon Wayne Petersen, MSW, LICSW
• Lisa Petersen, LCMHC
• Olivia Frances Petersen
• Gabriella Petrelli, ND

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.