NPIMap

Organization Active NPI

Woburn Pediatric Psychological Services PLLC

  • Psychiatry Physician
  • Woburn, MA
National Provider Identifier
1053716829
Registry record updated Oct 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
WOBURN PEDIATRIC PSYCHOLOGICAL SERVICES PLLC
Practice address
7 Alfred St
Baldwin Park II
Woburn, MA 01801-1976
Phone
(781) 933-6236
NPI assigned
Oct 23, 2014
Last updated
Oct 23, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
WOBURN PEDIATRIC ASSOCIATESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 23, 2014

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

Authorized official

Name
John Petrarca
Title
Executive Director
Phone
(781) 638-1020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

7 Alfred St
Baldwin Park II
Woburn, MA 01801-1976

Mailing address

7 Alfred St
Baldwin Park II
Woburn, MA 01801-1976
Phone (781) 933-6236

National Provider Directory

National Provider Directory
Part of
North Andover Pediatric Associates

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1414022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414022400000",
    "number": "1053716829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 ALFRED ST",
            "address_2": "BALDWIN PARK II",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018011976",
            "telephone_number": "781-933-6236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 ALFRED ST",
            "address_2": "BALDWIN PARK II",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018011976",
            "telephone_number": "781-933-6236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOBURN PEDIATRIC PSYCHOLOGICAL SERVICES PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WOBURN PEDIATRIC ASSOCIATES",
        "enumeration_date": "2014-10-23",
        "last_updated": "2014-10-23",
        "status": "A",
        "authorized_official_last_name": "PETRARCA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "781-638-1020"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Oct 23, 2014; 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.