Highland Psychological Associates, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

9580 Issued in MA

Legal business name

HIGHLAND PSYCHOLOGICAL ASSOCIATES, LLC

Practice address

875 Massachusetts Ave
Suite 71
Cambridge, MA 02139-3067

Phone

(857) 600-0875

NPI assigned

Nov 23, 2012

Last updated

Aug 14, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kelly R Wilson, PH.D.NPI 1740596279

Title

Owner

Phone

(857) 600-0875

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kelly R Wilson, PH.D.

  • Clinical Psychologist
  • Cambridge, MA
  • NPI 1740596279
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1353628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439510400000",
    "number": "1033453584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 MASSACHUSETTS AVE",
            "address_2": "SUITE 71",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021393067",
            "telephone_number": "857-600-0875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 MASSACHUSETTS AVE",
            "address_2": "SUITE 71",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021393067",
            "telephone_number": "857-600-0875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGHLAND PSYCHOLOGICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-23",
        "last_updated": "2015-08-14",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "857-600-0875",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "9580",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Cambridge, MA
• Providers in Cambridge, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.