Individual provider Active NPI

Maria Carmel Gurucharri, ED.D.

  • Clinical Child & Adolescent Psychologist
  • Boston, MA
National Provider Identifier
1023256336
Registry record updated Jan 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
3747 Issued in MA
Practice address
90 Warren Ave
McKinley Elementary
Boston, MA 02116
Phone
(617) 635-9978
Fax
(617) 635-9985
NPI assigned
Jan 23, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X 3747 MA Primary

Addresses

Primary practice location

90 Warren Ave
McKinley Elementary
Boston, MA 02116

Mailing address

90 Warren Ave
McKinley Elementary
Boston, MA 02116
Phone (617) 635-9978

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180423002057 MA Practitioner - Clinical Psychologist 1658634852 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3747MAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
FCP, Inc CurrentSince Feb 25, 2018 Accepting new patients

Locations

360 Merrimack St
Ste 3
Lawrence, MA 01843
Phone (978) 687-1617

76 Church St
Ste 301
Whitinsville, MA 01588
Phone (508) 234-4181

29 E Mountain St
Ste 2
Worcester, MA 01606
Phone (508) 450-1606

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1232668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1232668800000",
    "number": "1023256336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 WARREN AVE",
            "address_2": "MCKINLEY ELEMENTARY",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02116",
            "telephone_number": "617-635-9978",
            "fax_number": "617-635-9985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 WARREN AVE",
            "address_2": "MCKINLEY ELEMENTARY",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02116",
            "telephone_number": "617-635-9978",
            "fax_number": "617-635-9985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GURUCHARRI",
        "first_name": "MARIA",
        "middle_name": "CARMEL",
        "name_prefix": "Dr.",
        "credential": "ED.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-23",
        "last_updated": "2009-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MA",
            "license": "3747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.