Individual provider Active NPI

Melanie Puza Pearl, PH.D.

  • Psychologist
  • Ridgefield, CT
National Provider Identifier
1902109036
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
003049 Issued in CT
Practice address
38B Grove St Ste 1a
Ridgefield, CT 06877-4679
Phone
(203) 505-4564
NPI assigned
Dec 12, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PS016700 PA
Psychologist 103T00000X 018412 NY
Psychologist 103T00000X 003049 CT Primary

Addresses

Primary practice location

38B Grove St Ste 1a
Ridgefield, CT 06877-4679

Mailing address

38B Grove St Ste 1a
Ridgefield, CT 06877-4679
Phone (203) 505-4564

Other practice location 1

470 Main St
Suite 304
Ridgefield, CT 06877-4516
Phone (203) 505-4564

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
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
018412NYMDPsychologist
PS016700PAMDPsychologist
003049CTMDAcute Care Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1292112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1902109036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38B GROVE ST STE 1A",
            "city": "RIDGEFIELD",
            "state": "CT",
            "postal_code": "068774679",
            "telephone_number": "203-505-4564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38B GROVE ST STE 1A",
            "city": "RIDGEFIELD",
            "state": "CT",
            "postal_code": "068774679",
            "telephone_number": "203-505-4564"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "470 Main St",
            "address_2": "Suite 304",
            "address_purpose": "LOCATION",
            "city": "Ridgefield",
            "state": "CT",
            "postal_code": "068774516",
            "country_code": "US",
            "telephone_number": "203-505-4564",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEARL",
        "first_name": "MELANIE",
        "middle_name": "PUZA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-12-12",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS016700",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "018412",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CT",
            "license": "003049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgefield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.