Dr Kerrie LLC

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

Legal business name

DR KERRIE LLC

Practice address

10 Hawthorne Park
Cambridge, MA 02138-2104

Phone

(617) 372-5653

NPI assigned

Apr 7, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Kerrie Jongeneelen, PSY.D.NPI 1093966624

Title

Clinical Psychologist

Phone

(617) 372-5653

Specialties & licenses 4

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kerrie Jongeneelen, PSY.D.

  • Clinical Child & Adolescent Psychologist
  • Lexington, MA
  • NPI 1093966624
  NPD (past) Authorized official

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

{
    "created_epoch": "1554595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1033672100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 CONCORD AVE UNIT 386",
            "city": "BELMONT",
            "state": "MA",
            "postal_code": "024787818",
            "telephone_number": "617-372-5653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 HAWTHORNE PARK",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021382104",
            "telephone_number": "617-372-5653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR KERRIE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-07",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "JONGENEELEN",
        "authorized_official_first_name": "KERRIE",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "617-372-5653",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110138961",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Dougenik, RNCS
• Celeste Mazzeo Douglas, PT, DPT
• Nichola Douglas, CNM
• Shannon Marie Douglass, LPN
• Lisa Christine Doyle
• Dr Scott W Sylvia & Assoc PC
• Dr. Luan PLLC
• Dr. Susan Pories
• Dr. Susan Pories
• Dr.Peter Tian

• Clinical Child & Adolescent Psychologist in Cambridge, MA
• Providers in Cambridge, MA by specialty
• Clinical Child & Adolescent Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.