Active NPI
Kevin T Mundt, PSYD
- Psychologist
- Medford, MA
National Provider Identifier
1124896915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 11746
- Practice address
- 11 Garden St
Medford, MA 02155-3219 - Phone
- (551) 427-3290
- NPI assigned
- Dec 12, 2023
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 11746 | NJ | Primary |
Addresses
Primary practice location
11 Garden St
Medford, MA 02155-3219
Mailing address
11 Garden St
Medford, MA 02155-3219
Phone (551) 427-3290
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11746 | NJ | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1702339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702339200000",
"number": "1124896915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 GARDEN ST",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021553219",
"telephone_number": "551-427-3290"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 GARDEN ST",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021553219",
"telephone_number": "551-427-3290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUNDT",
"first_name": "KEVIN",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-12-12",
"last_updated": "2023-12-12",
"certification_date": "2023-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NJ",
"license": "11746",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.