Active NPI
Mindy Sue Kopolow, M.A., PSY.D.
- Clinical Psychologist
- Woburn, MA
National Provider Identifier
1053583120
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 8603
- Practice address
- 400 W Cummings Park
Suite 3400
Woburn, MA 01801-6519 - Phone
- (617) 972-5055
- Fax
- (617) 972-5011
- NPI assigned
- Mar 29, 2008
- Last updated
- Apr 4, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 851 | MA | |
| Clinical Psychologist | 103TC0700X | 8603 | MA | Primary |
| Clinical Psychologist | 103TC0700X | PY5819 | FL |
Addresses
Primary practice location
400 W Cummings Park
Suite 3400
Woburn, MA 01801-6519
Mailing address
400 W Cummings Park
Suite 3400
Woburn, MA 01801-6519
Phone (617) 972-5055
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 54439 | Other | FL | BCBS OF FLORIDA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 5, 2022 through Dec 5, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY5819 | FL | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mindy S Kopolow PSYD PA | Mental Health | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365033600000",
"number": "1053583120",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 W CUMMINGS PARK",
"address_2": "SUITE 3400",
"city": "WOBURN",
"state": "MA",
"postal_code": "018016519",
"telephone_number": "617-972-5055",
"fax_number": "617-972-5011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 W CUMMINGS PARK",
"address_2": "SUITE 3400",
"city": "WOBURN",
"state": "MA",
"postal_code": "018016519",
"telephone_number": "617-972-5055",
"fax_number": "617-972-5011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOPOLOW",
"first_name": "MINDY",
"middle_name": "SUE",
"name_prefix": "Dr.",
"credential": "M.A., PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-03-29",
"last_updated": "2013-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MA",
"license": "851",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "8603",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY5819",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF FLORIDA",
"identifier": "54439",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Woburn, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.