Advanced Neurotherapy, PC
Organization Active NPI Cognitive & Behavioral Psychologist · Wellesley, MA
NPI 1104846476 · NPPES record last updated Jun 15, 2023
Key facts
- NPI
- 1104846476
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Cognitive & Behavioral Psychologist 103TB0200X
- License
- 3976 (MA)
- Legal business name
- ADVANCED NEUROTHERAPY, PC
- Practice address
- 140 Bristol Rd
Wellesley, MA 02481-2730 - Phone
- (781) 444-9115
- NPI assigned
- Jul 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Jolene Ross, PH.D.
- Title
- Licensed Psychologist/Director
- Phone
- (781) 444-9115
Practitioners 1
-
Jolene Ross, PH.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070219000138 | MA | Part B Supplier - Clinic/Group Practice | 4385746569 |
Receives reassigned benefits from 1 practitioner Practice locations: Wellesley, MA |
National Provider Directory
Locations
145 Rosemary St
Ste J
Needham Heights, MA 02494
Phone (617) 938-3999
27 Mica Ln
Ste 102
Wellesley, MA 02481
Phone (781) 431-9115
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist |
103TB0200X | 3976 | MA | Yes |
Addresses
Primary practice location
140 Bristol Rd
Wellesley, MA 02481-2730
Mailing address
10436 Park Tree PL
Glen Allen, VA 23060-4487
Phone (781) 444-9115
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 722869 | Other | MA | TUFTS COMMERCIAL |
| W03950 | Other | MA | BCBS PROVIDER # |
| W03950 | Other | MA | NATIONAL HERITAGE |
Other providers in Wellesley, MA
- Accurate Aesthetics
- Accurate Aesthetics Plastic Surgery, P.C.
- Susan Louise Adamson
- Lauren Joy Adelizi
- Charles E. Adler
- Advanced Sports Therapy, LLC
- Aneel Advani
- Adviniacare Newton Wellesley LLC
- David Shaun Aghassi
- Sarah Al Alam
All providers in Wellesley, MA · Cognitive & Behavioral Psychologist in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 15, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.