NPIMap

Organization Active NPI

Psychmatrix for Child & Adolescent Psychiatry, LLC

  • Psychiatry Physician
  • Wilbraham, MA
National Provider Identifier
1124227905
Registry record updated Jul 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
73294 Issued in MA
Legal business name
PSYCHMATRIX FOR CHILD & ADOLESCENT PSYCHIATRY, LLC
Practice address
35 Post Office Park Ste 3505
Wilbraham, MA 01095-1186
Phone
(413) 596-4601
Fax
(413) 596-4609
NPI assigned
Jul 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2007

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

Authorized official

Name
Susan Cary, MDNPI 1851497028
Title
Owner
Phone
(413) 596-4601

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X 73294 MA Primary

Addresses

Primary practice location

35 Post Office Park Ste 3505
Wilbraham, MA 01095-1186

Mailing address

12 Ruth Dr
Wilbraham, MA 01095-2610
Phone (413) 596-4601

Other identifiers 3

IdentifierTypeStateIssuer
3078540MedicaidMA
586023OtherMATUFTS
M18872OtherMABCBS

National Provider Directory

National Provider Directory

Locations

35 Post Office Park
Ste 3505
Wilbraham, MA 01095
Phone (413) 596-4601

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1184198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184198400000",
    "number": "1124227905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 RUTH DR",
            "city": "WILBRAHAM",
            "state": "MA",
            "postal_code": "010952610",
            "telephone_number": "413-596-4601",
            "fax_number": "413-596-4609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 POST OFFICE PARK STE 3505",
            "city": "WILBRAHAM",
            "state": "MA",
            "postal_code": "010951186",
            "telephone_number": "413-596-4601",
            "fax_number": "413-596-4609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHMATRIX FOR CHILD & ADOLESCENT PSYCHIATRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-12",
        "last_updated": "2007-07-12",
        "status": "A",
        "authorized_official_last_name": "CARY",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "413-596-4601",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "73294",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3078540",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "586023",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "M18872",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilbraham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2007; 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.