Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Courtney Roler Mauzy IV, BCBAPHD

Individual provider Behavior Analyst · NPI 1366228025

Courtney Roler Mauzy IV, BCBAPHD is a Clinical Psychologist in Syracuse, New York. Qualified in 2022, 4 years ago. Practices with Pediatric Service Group, a 17-clinician group and accepts Medicare assignment. Licensed in Georgia and New York.

Years since qualifying
4
Licensed in
GA, NY
In the registry since
2023
Specialties on file
2
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Practice location Address checks out

475 Irving Ave
Syracuse, NY 13210-1756
Phone: (315) 464-3555
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychologist (primary) Taxonomy 103T00000X · Licence 332649 (NY)
Behavior Analyst Taxonomy 103K00000X · Licence 1-20-44673 (GA)

Record details

NPI number1366228025
Entity typeIndividual (Type 1)
GenderMale
Credentials BCBAPHD
Sole proprietorNo
NPI enumeratedSeptember 7, 2023
Last updated in NPPESSeptember 19, 2024
Certification dateSeptember 7, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Pediatric Service Group — 17 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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