Alexander Lodge, MA

Primary specialty

PsychologistTaxonomy code 103T00000X

License

047.0133699 Issued in VT

Practice address

75 Talcott Rd Ste 30
Williston, VT 05495-8122

Phone

(802) 503-2929

NPI assigned

Sep 19, 2022

Sex

Male

Sole proprietor

Yes

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

Specialty

Mental Health Counselor

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

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 and National Provider Directory roles.

• Xander Lodge, Ma, PLC

  dba Lodge Psychotherapy

  • Psychologist
  • Williston, VT
  • NPI 1255053930
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1663545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706486400000",
    "number": "1720700404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 METCALF DR",
            "city": "WILLISTON",
            "state": "VT",
            "postal_code": "054958802",
            "telephone_number": "802-503-2929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 TALCOTT RD STE 30",
            "city": "WILLISTON",
            "state": "VT",
            "postal_code": "054958122",
            "telephone_number": "802-503-2929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LODGE",
        "first_name": "ALEXANDER",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-19",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VT",
            "license": "047.0133699",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "VT",
            "license": "047.0133699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Elizabeth Lillich, PHD
• Hercules Liotard, CMT
• Jason Lippman, MD
• Lisa Hardy, Aprn, PLLC (Optimind Mental Health & Wellness)
• Siyu Liu, PHARMD
• Elizabeth Kathryn Loscalzo, PA-C
• Liam Loughlin, BCBA, LBA, MA
• Luciana Flores DDS PLLC
• Anastasiya Lulic, FNP
• Sagui Lutman, OTR

• Psychologist in Williston, VT
• Providers in Williston, VT by specialty
• Psychologist in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 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.