Jeffrey Twarog – Cognitive & Behavioral Psychologist

Key facts

NPI: 1013082239
Entity type: Individual (NPI type 1)
Primary specialty: Cognitive & Behavioral Psychologist 103TB0200X
License: 1852 (MA)
Practice address: 109 Roosevelt Rd
Cotuit, MA 02635-2713
Phone: (508) 428-4307
Fax: (508) 420-5542
NPI assigned: Nov 22, 2006
Sex: Male
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Cognitive & Behavioral Psychologist	103TB0200X	1852	MA	Yes

Addresses

Primary practice location

109 Roosevelt Rd
Cotuit, MA 02635-2713

Mailing address

109 Roosevelt Rd
Cotuit, MA 02635-2713
Phone (508) 428-4307

Other identifiers

Identifier	Type	State	Issuer
W02010	Other	MA	BLUE CROSS BLUE SHIELD MA
0504467	Medicaid	MA

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013082239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 ROOSEVELT RD",
            "city": "COTUIT",
            "state": "MA",
            "postal_code": "026352713",
            "telephone_number": "508-428-4307",
            "fax_number": "508-420-5542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 ROOSEVELT RD",
            "city": "COTUIT",
            "state": "MA",
            "postal_code": "026352713",
            "telephone_number": "508-428-4307",
            "fax_number": "508-420-5542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TWAROG",
        "first_name": "JEFFREY",
        "name_prefix": "Dr.",
        "credential": "ED.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MA",
            "license": "1852",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MA",
            "identifier": "W02010",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0504467",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cotuit, MA

All providers in Cotuit, MA · Cognitive & Behavioral Psychologist in Massachusetts

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.