NPIMap

Organization Active NPI

Soren R. Ekstrom, Inc.

  • Clinical Psychologist
  • Watertown, MA
National Provider Identifier
1134421902
Registry record updated Nov 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
3505 Issued in MA
Legal business name
SOREN R. EKSTROM, INC.
Practice address
29 Chester St
Watertown, MA 02472-4002
Phone
(617) 923-6086
NPI assigned
Nov 29, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2010

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

Authorized official

Name
Dr. Soren R. Ekstrom, PH.D.
Title
Sole Propietor
Phone
(617) 923-6086

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 3505 MA Primary

Addresses

Primary practice location

29 Chester St
Watertown, MA 02472-4002

Mailing address

29 Chester St
Watertown, MA 02472-4002
Phone (617) 923-6086

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1290988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290988800000",
    "number": "1134421902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 CHESTER ST",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "024724002",
            "telephone_number": "617-923-6086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 CHESTER ST",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "024724002",
            "telephone_number": "617-923-6086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOREN R. EKSTROM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-29",
        "last_updated": "2010-11-29",
        "status": "A",
        "authorized_official_last_name": "EKSTROM",
        "authorized_official_first_name": "SOREN",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "SOLE PROPIETOR",
        "authorized_official_telephone_number": "617-923-6086",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "3505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2010; 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.