NPIMap

Organization Active NPI

Mindy S Kopolow PSYD PA

  • Clinical Psychologist
  • Woburn, MA
National Provider Identifier
1073633327
Registry record updated Apr 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
8603 Issued in MA
Legal business name
MINDY S KOPOLOW PSYD PA
Practice address
400 W Cummings Park
Suite 3400
Woburn, MA 01801-6519
Phone
(617) 972-5055
Fax
(617) 972-5011
NPI assigned
Mar 30, 2007
Last updated
Apr 4, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2013

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

Authorized official

Name
Dr. Mindy Sue Kopolow, MA, PSYDNPI 1053583120
Title
President
Phone
(617) 972-5055

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 851 MA
Clinical Psychologist 103TC0700X PY5819 FL
Clinical Psychologist 103TC0700X 8603 MA Primary

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

IdentifierTypeStateIssuer
54439OtherFLBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

400 W Cummings Park
Ste 3400
Woburn, MA 01801
Phone (617) 972-5055

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365033600000",
    "number": "1073633327",
    "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": {
        "organization_name": "MINDY S KOPOLOW PSYD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2013-04-04",
        "status": "A",
        "authorized_official_last_name": "KOPOLOW",
        "authorized_official_first_name": "MINDY",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-972-5055",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MA, PSYD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "851",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY5819",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "8603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.