Active NPI
Wayne F Tyrrell, SC.D.
- Psychologist
- South Hero, VT
National Provider Identifier
1639669013
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 4560-PY-PR
- Practice address
- 82 Lakeview Rd
South Hero, VT 05486-4600 - Phone
- (802) 777-9093
- NPI assigned
- May 11, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 4560-PY-PR | MA | Primary |
Addresses
Primary practice location
82 Lakeview Rd
South Hero, VT 05486-4600
Mailing address
82 Lakeview Rd
South Hero, VT 05486-4600
Phone (802) 777-9093
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4560-PY-PR | MA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525996800000",
"number": "1639669013",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "82 LAKEVIEW RD",
"city": "SOUTH HERO",
"state": "VT",
"postal_code": "054864600",
"telephone_number": "802-777-9093"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "82 LAKEVIEW RD",
"city": "SOUTH HERO",
"state": "VT",
"postal_code": "054864600",
"telephone_number": "802-777-9093"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TYRRELL",
"first_name": "WAYNE",
"middle_name": "F",
"credential": "SC.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-05-11",
"last_updated": "2018-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "4560-PY-PR",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Hero, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.