Pca in Pediatric Primary Care LLC

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

Legal business name

PCA IN PEDIATRIC PRIMARY CARE LLC

Practice address

12 Alfred St
Suite 200
Woburn, MA 01801-1972

Phone

(781) 646-0500

Fax

(781) 646-7130

NPI assigned

Nov 26, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Michael F Jacques, PHD

Title

Owner

Phone

(781) 646-0500

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1385424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385424000000",
    "number": "1013347103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 ALFRED ST",
            "address_2": "SUITE 200",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018011972",
            "telephone_number": "781-646-0500",
            "fax_number": "781-646-7130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 ALFRED ST",
            "address_2": "SUITE 200",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018011972",
            "telephone_number": "781-646-0500",
            "fax_number": "781-646-7130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PCA IN PEDIATRIC PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-26",
        "last_updated": "2013-11-26",
        "status": "A",
        "authorized_official_last_name": "JACQUES",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "781-646-0500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Pavao, COTA
• Pax Animi
• Marilyn Ruth Paykuss, M.ED., C.A.E.S.
• Jeremy M Payne, OT
• Rachel Paynter, PTA
• Pca in Primary Care LLC
• Dennis Peary, OTD, OTR/L
• Tara Pede
• Pediatric&Family Dentistry of Woburn
• Amanda Pedicini, WHNP-BC

• Counseling Psychologist in Woburn, MA
• Providers in Woburn, MA by specialty
• Counseling Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.