Active NPI
Alexandra Broustovetskaia, PH.D.
- Counseling Psychologist
- Raleigh, NC
National Provider Identifier
1124516026
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 10641
- Practice address
- 8303 Six Forks Rd Ste 207
Raleigh, NC 27615 - Phone
- (919) 245-7791
- NPI assigned
- Apr 25, 2018
- Last updated
- Oct 2, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 10641 | MA | Primary |
Addresses
Primary practice location
8303 Six Forks Rd Ste 207
Raleigh, NC 27615
Mailing address
8303 Six Forks Rd Ste 207
Raleigh, NC 27615-3094
Phone (919) 245-7791
Other practice location 1
400 Fenway
Boston, MA 02115-5725
Phone (617) 735-9920
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Oct 2, 2018 through Oct 2, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10641 | MA | MD | Counseling Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Breyta Psychological Services, P.a. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Psychologist
- Raleigh, NC
- NPI 1871076406
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1538438400000",
"number": "1124516026",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8303 SIX FORKS RD STE 207",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276153094",
"telephone_number": "919-245-7791"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8303 SIX FORKS RD STE 207",
"city": "RALEIGH",
"state": "NC",
"postal_code": "27615",
"telephone_number": "919-245-7791"
}
],
"practiceLocations": [
{
"address_1": "400 Fenway",
"address_purpose": "LOCATION",
"city": "Boston",
"state": "MA",
"postal_code": "021155725",
"country_code": "US",
"telephone_number": "617-735-9920",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BROUSTOVETSKAIA",
"first_name": "ALEXANDRA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-04-25",
"last_updated": "2018-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "MA",
"license": "10641",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.