Active NPI
Judith Wilner Lawrence
- Clinical Psychologist
- Brookline, MA
National Provider Identifier
1013062827
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 7154
- Practice address
- 1577 Beacon St
Brookline, MA 02446-4602 - Phone
- (617) 739-1212
- Fax
- (617) 731-8585
- NPI assigned
- Jan 24, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 7154 | MA | Primary |
Addresses
Primary practice location
1577 Beacon St
Brookline, MA 02446-4602
Mailing address
1577 Beacon St
Brookline, MA 02446-4602
Phone (617) 739-1212
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7154 | Other | MA | STATE PSYCHOLOGY LICENSE |
| W05753 | Other | MA | BCBS PIN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 15, 2024 through Feb 15, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7154 | MA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013062827",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1577 BEACON ST",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024464602",
"telephone_number": "617-739-1212",
"fax_number": "617-731-8585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1577 BEACON ST",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024464602",
"telephone_number": "617-739-1212",
"fax_number": "617-731-8585"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAWRENCE",
"first_name": "JUDITH",
"middle_name": "WILNER",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "7154",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE PSYCHOLOGY LICENSE",
"identifier": "7154",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PIN",
"identifier": "W05753",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brookline, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.