Active NPI
Theodore Paul Cross, PH.D.
- Clinical Psychologist
- Lexington, MA
National Provider Identifier
1104062942
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 4645
- Practice address
- 4 Militia Dr
Lexington, MA 02421-4737 - Phone
- (781) 640-4521
- NPI assigned
- Dec 29, 2008
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 4645 | MA | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 4645 | MA |
Addresses
Primary practice location
4 Militia Dr
Lexington, MA 02421-4737
Mailing address
60 Maynard St
Arlington, MA 02474-2318
Phone (781) 640-4532
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 |
|---|---|---|---|
| 4645 | MA | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1230508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1230508800000",
"number": "1104062942",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "60 MAYNARD ST",
"city": "ARLINGTON",
"state": "MA",
"postal_code": "024742318",
"telephone_number": "781-640-4532"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4 MILITIA DR",
"city": "LEXINGTON",
"state": "MA",
"postal_code": "024214737",
"telephone_number": "781-640-4521"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROSS",
"first_name": "THEODORE",
"middle_name": "PAUL",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-12-29",
"last_updated": "2008-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "4645",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MA",
"license": "4645",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lexington, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.