Diana Michalczuk, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

048.0086156 Issued in VT

Practice address

357 Shields Dr
Bennington, VT 05201-9810

Phone

(802) 447-1409

Fax

(802) 442-5199

NPI assigned

Sep 15, 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 identifiers 2

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, 2010

Medicare assignment

May accept Medicare assignment

Group practices

Memory Clinic IncGroup PAC ID 6709209109, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Memory Clinic, Inc.

  • Behavioral Neurology & Neuropsychiatry Physician
  • Bennington, VT
  • NPI 1205359213

  Psychologist

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1221436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372377600000",
    "number": "1760631774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "357 SHIELDS DR",
            "city": "BENNINGTON",
            "state": "VT",
            "postal_code": "052019810",
            "telephone_number": "802-447-1409",
            "fax_number": "802-442-5199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "357 SHIELDS DR",
            "city": "BENNINGTON",
            "state": "VT",
            "postal_code": "052019810",
            "telephone_number": "802-447-1409",
            "fax_number": "802-442-5199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICHALCZUK",
        "first_name": "DIANA",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-15",
        "last_updated": "2013-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "VT",
            "license": "048.0086156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "003006801",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01173650",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Memory Clinic, Inc.
• Ronald S. Mensh, MD
• Daniel Merges, MA
• MHP Healthcare LLC (Extended Care Pharmacy LLC)
• Whitney P Mical, FNP
• Robert J Miller, D.D.S.
• Mindful Solutions PLLC
• Wanda Christine Minenna, NP
• Katherine Miskovsky, M.ED.
• Mackenzie Lucille Mitchell

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2013; 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.