Active NPI
Rebecca S. Kornblatt, PSY.D.
- Clinical Psychologist
- Newton, MA
National Provider Identifier
1174710669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 9176
- Practice address
- 10 Langley Rd
Suite 200
Newton, MA 02459-1972 - Phone
- (617) 615-6525
- NPI assigned
- Sep 27, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 017233-1 | NY | |
| Clinical Psychologist | 103TC0700X | 9176 | MA | Primary |
Addresses
Primary practice location
10 Langley Rd
Suite 200
Newton, MA 02459-1972
Mailing address
10 Langley Rd
Suite 200
Newton, MA 02459-1972
Phone (617) 615-6525
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0015725 | Other | MA | MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 9, 2025 through Jun 9, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9176 | MA | MD | Physical Therapist |
| 017233-1 | NY | MD | Hand Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326844800000",
"number": "1174710669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 LANGLEY RD",
"address_2": "SUITE 200",
"city": "NEWTON",
"state": "MA",
"postal_code": "024591972",
"telephone_number": "617-615-6525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 LANGLEY RD",
"address_2": "SUITE 200",
"city": "NEWTON",
"state": "MA",
"postal_code": "024591972",
"telephone_number": "617-615-6525"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KORNBLATT",
"first_name": "REBECCA",
"middle_name": "S.",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-09-27",
"last_updated": "2012-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "017233-1",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "9176",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "0015725",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.