Active NPI
Michael Neessen, PSYD
- Clinical Psychologist
- Braintree, MA
National Provider Identifier
1194772830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 8553
- Practice address
- 639 Granite St
Suite LL15
Braintree, MA 02184 - Phone
- (781) 390-3922
- Fax
- (781) 390-3922
- NPI assigned
- May 28, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 8553 | MA | Primary |
Addresses
Primary practice location
639 Granite St
Suite LL15
Braintree, MA 02184
Mailing address
189 Warren Ave
#2
Boston, MA 02116
Phone (617) 529-7629
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8553 | MA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1194772830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "189 WARREN AVE",
"address_2": "#2",
"city": "BOSTON",
"state": "MA",
"postal_code": "02116",
"telephone_number": "617-529-7629",
"fax_number": "781-390-3922"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "639 GRANITE ST",
"address_2": "SUITE LL15",
"city": "BRAINTREE",
"state": "MA",
"postal_code": "02184",
"telephone_number": "781-390-3922",
"fax_number": "781-390-3922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEESSEN",
"first_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "8553",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Braintree, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.