Active NPI
Patricio Dhimitri, PSYCHOLOGIST
- Psychologist
- Lawrence, MA
National Provider Identifier
1023130960
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2431
- Practice address
- 599 Canal St
Lawrence, MA 01840-1244 - Phone
- (978) 687-6488
- Fax
- (978) 687-4511
- NPI assigned
- Apr 4, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2431 | MA | Primary |
Addresses
Primary practice location
599 Canal St
Lawrence, MA 01840-1244
Mailing address
599 Canal St
Lawrence, MA 01840-1244
Phone (978) 687-6488
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0507962 | Medicaid | MA | |
| WO2659 | Other | MA | BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120912000425 | MA | Practitioner - Clinical Psychologist | 6002075363 | Practice locations: Lawrence, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1978
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
599 Canal St
Lawrence, MA 01840-1244
Phone (508) 801-0368
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2431 | MA | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346976000000",
"number": "1023130960",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "599 CANAL ST",
"city": "LAWRENCE",
"state": "MA",
"postal_code": "018401244",
"telephone_number": "978-687-6488",
"fax_number": "978-687-4511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "599 CANAL ST",
"city": "LAWRENCE",
"state": "MA",
"postal_code": "018401244",
"telephone_number": "978-687-6488",
"fax_number": "978-687-4511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DHIMITRI",
"first_name": "PATRICIO",
"name_prefix": "Dr.",
"credential": "PSYCHOLOGIST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-04",
"last_updated": "2012-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "2431",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0507962",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "WO2659",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lawrence, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.