NPIMap

Organization Active NPI

Revive Behavioral Health

  • Behavioral Neurology & Neuropsychiatry Physician
  • Petersburg, VA
National Provider Identifier
1942055504
Registry record updated Sep 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavioral Neurology & Neuropsychiatry PhysicianTaxonomy code 2084B0040X
Legal business name
REVIVE BEHAVIORAL HEALTH
Doing business as
Revive Behavioral Health
Practice address
416 3Rd St Ste D
Petersburg, VA 23803-3300
Phone
(804) 653-7009
Fax
(804) 773-4688
NPI assigned
Apr 18, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2025

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

Authorized official

Name
Hailey Mazzei
Title
Owner
Phone
(804) 490-3226

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavioral Neurology & Neuropsychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084B0040X Primary

Addresses

Primary practice location

416 3Rd St Ste D
Petersburg, VA 23803-3300

Mailing address

416 3Rd St Ste D
Petersburg, VA 23803-3300
Phone (804) 653-7009

Other names 1

  • Revive Behavioral Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250113003787 VA Part B Supplier - Clinic/Group Practice 8729516125 Receives reassigned benefits from 7 practitioners
Practice locations: Petersburg, VA

National Provider Directory

National Provider Directory

Locations

416 3rd St
Ste D
Petersburg, VA 23803
Phone (804) 653-7009

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1713398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757721600000",
    "number": "1942055504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 3RD ST STE D",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238033300",
            "telephone_number": "804-653-7009",
            "fax_number": "804-773-4688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 3RD ST STE D",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238033300",
            "telephone_number": "804-653-7009",
            "fax_number": "804-773-4688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-18",
        "last_updated": "2025-09-13",
        "certification_date": "2025-09-13",
        "status": "A",
        "authorized_official_last_name": "MAZZEI",
        "authorized_official_first_name": "HAILEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "804-490-3226"
    },
    "taxonomies": [
        {
            "code": "2084B0040X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revive Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Revive Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Petersburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.