DR. LISA M PEZZULICH (PSY.D.) – Clinical Psychologist, NPI 1417040767

DR. LISA M PEZZULICH (PSY.D.) is a healthcare provider. based in Bennington, Vermont. specializing in CLINICAL PSYCHOLOGIST. They hold the professional credentials PSY.D.. They hold a License No. 048-0000729 (VT). The NPI Number for DR. LISA M PEZZULICH (PSY.D.) is 1417040767

Main info

Female
29 Years Of Experience
Accepts Medicare Assignment
Name
DR. LISA M PEZZULICH (PSY.D.)
NPI
1417040767
Phone
(802) 442-3520
Address
160 BENMONT AVE
Enumeration Date
1 October 2006
Last Update Date
22 July 2010

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8024423520211
Graduation Year
1997 (29 years ago)
PAC ID
6204918741
Group Practice PAC ID
0749472967
Professional Enrollment ID
I20080811000570
Address ID
VT052011842BE160XXAVEX302
Telehealth
Yes
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience52
Completeness75
Years active:19State licenses:1Digital endpointsOther names

169 CLINICAL PSYCHOLOGIST in VT

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Provider Addresses for DR. LISA M PEZZULICH (PSY.D.)

  • 160, Benmont Avenue, Bennington, Bennington County, Vermont, 05201, United States

    SUITE 20

    BENNINGTON, VT 052011873

    Phone: (802) 442-3520

    Fax: (802) 447-3392

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2008-08-11

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20080811000570IClinical PsychologistVTTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
90837Psychotherapy, 1 hour21212$0
View full utilization report →

Insurance plans in this area (ZIP 05201)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 0749472967View full group profile
NameSpecialtyState
Clinical PsychologistVT

Reviews

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Frequently asked questions

How do I look up DR. LISA M PEZZULICH (PSY.D.) by NPI?
Use NPI 1417040767 when you need to reference DR. LISA M PEZZULICH (PSY.D.) in forms, claims, or directories.
Does this profile mean DR. LISA M PEZZULICH (PSY.D.) is currently active?
Yes — DR. LISA M PEZZULICH (PSY.D.) appears active in the national provider directory.
What does DR. LISA M PEZZULICH (PSY.D.) treat or focus on?
Patients typically see DR. LISA M PEZZULICH (PSY.D.) under the specialty Clinical Psychologist. Clinical services aligned with this taxonomy classification.
What location shows for DR. LISA M PEZZULICH (PSY.D.)?
We surface Bennington, Vermont for DR. LISA M PEZZULICH (PSY.D.) based on available NPPES addresses.
How can I contact DR. LISA M PEZZULICH (PSY.D.)?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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