Active NPI
Alyssa Tiana Frederique, PSYD
- Psychologist
- Boston, MA
National Provider Identifier
1043085079
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 24 New Chardon St
Boston, MA 02114-4703 - Phone
- (617) 865-3591
- NPI assigned
- Nov 20, 2023
- Sex
- Female
- Sole proprietor
- No
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 | MA | Primary |
Addresses
Primary practice location
24 New Chardon St
Boston, MA 02114-4703
Mailing address
51 Country Club Dr
Brockton, MA 02301-7001
Phone (978) 985-9110
Other practice location 1
875 Massachusetts Ave
Cambridge, MA 02139-3067
Phone (617) 420-5251 ext. 12725
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1700438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700438400000",
"number": "1043085079",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "51 COUNTRY CLUB DR",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023017001",
"telephone_number": "978-985-9110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24 NEW CHARDON ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021144703",
"telephone_number": "617-865-3591"
}
],
"practiceLocations": [
{
"address_1": "875 Massachusetts Ave",
"address_purpose": "LOCATION",
"city": "Cambridge",
"state": "MA",
"postal_code": "021393067",
"country_code": "US",
"telephone_number": "617-420-5251 x12725",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FREDERIQUE",
"first_name": "ALYSSA",
"middle_name": "TIANA",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-11-20",
"last_updated": "2023-11-20",
"certification_date": "2023-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.