Masha Y Ivanova, PHD

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

048-0000914 Issued in VT

Practice address

1 South Prospect Street
Uhc St Josephs Wing 3Rd Floor
Burlington, VT 05401

Phone

(802) 656-2796

NPI assigned

May 19, 2008

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 names 1

• Maria Y Ivanova Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1211155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211155200000",
    "number": "1700043759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SOUTH PROSPECT STREET",
            "address_2": "UHC ST JOSEPHS WING 3RD FLOOR",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "05401",
            "telephone_number": "802-656-2796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SOUTH PROSPECT STREET",
            "address_2": "UHC ST JOSEPHS WING 3RD FLOOR",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "05401",
            "telephone_number": "802-656-2796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVANOVA",
        "first_name": "MASHA",
        "middle_name": "Y",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-19",
        "last_updated": "2008-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "VT",
            "license": "048-0000914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIA",
            "last_name": "IVANOVA",
            "middle_name": "Y",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Shannon Irvine-Marsh, MD
• Andrew Irvine
• Brian Hilbert Irwin, M.D.
• Elizabeth Isaacoff, MD
• Frank Paul Ittleman, MD
• Clarence Sherman Ivie III, D.O.
• Laura Biron Ivins, LICSW, AAP
• Anita Subramanian Iyer, M.D.
• J Allen Puma OD PC
• Jab Inc

• Clinical Child & Adolescent Psychologist in Burlington, VT
• Providers in Burlington, VT by specialty
• Clinical Child & Adolescent Psychologist in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.