Active NPI
Jonathan Joshua Entis, PH.D
- Counseling Psychologist
- Cambridge, MA
National Provider Identifier
1053773150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 10695
- Practice address
- 240 Concord Ave
Cambridge, MA 02138 - Phone
- (617) 702-2733
- NPI assigned
- Mar 28, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Group Psychotherapy Psychologist | 103TP2701X | 10695 | MA | |
| Counseling Psychologist | 103TC1900X | 10695 | MA | Primary |
Addresses
Primary practice location
240 Concord Ave
Cambridge, MA 02138
Mailing address
240 Concord Ave
Cambridge, MA 02138-1337
Phone (617) 702-2733
Other practice location 1
2294 Massachusetts Ave
Cambridge, MA 02140-1812
Phone (617) 702-2733
Other practice location 2
2294 Massachusetts Ave
Cambridge, MA 02140-1812
Phone (617) 702-2733
Other practice location 3
1493 Cambridge St
Cambridge, MA 02139-1047
Phone (617) 665-1183
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10695 | MA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1459123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565568000000",
"number": "1053773150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "240 CONCORD AVE",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021381337",
"telephone_number": "617-702-2733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "240 CONCORD AVE",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "02138",
"telephone_number": "617-702-2733"
}
],
"practiceLocations": [
{
"address_1": "2294 Massachusetts Ave",
"address_purpose": "LOCATION",
"city": "Cambridge",
"state": "MA",
"postal_code": "021401812",
"country_code": "US",
"telephone_number": "617-702-2733",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2294 Massachusetts Ave",
"address_purpose": "LOCATION",
"city": "Cambridge",
"state": "MA",
"postal_code": "021401812",
"country_code": "US",
"telephone_number": "617-702-2733",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1493 Cambridge St",
"address_purpose": "LOCATION",
"city": "Cambridge",
"state": "MA",
"postal_code": "021391047",
"country_code": "US",
"telephone_number": "617-665-1183",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ENTIS",
"first_name": "JONATHAN",
"middle_name": "JOSHUA",
"name_prefix": "Dr.",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-03-28",
"last_updated": "2019-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "103TP2701X",
"taxonomy_group": "",
"desc": "Psychologist, Group Psychotherapy",
"state": "MA",
"license": "10695",
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "MA",
"license": "10695",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cambridge, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 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.