Kenneth I Wilson, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3882 Issued in MA

Practice address

12 Alfred St Ste 200
Woburn, MA 01801-1915

Phone

(781) 646-0500

Fax

(781) 646-7130

NPI assigned

Mar 24, 2006

Last updated

Dec 20, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Hahnemann University College of Medicine, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Child and Family Psychological Services PLLCGroup PAC ID 5991763823, 260 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Child and Family Psychological Services, PLLC

  dba LifeStance Health

  • Psychologist
  • Norwood, MA
  • NPI 1912987181

  Clinical

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608422400000",
    "number": "1194785287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 ALFRED ST STE 200",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018011915",
            "telephone_number": "781-646-0500",
            "fax_number": "781-646-7130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 ALFRED ST STE 200",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018011915",
            "telephone_number": "781-646-0500",
            "fax_number": "781-646-7130"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22 Mill St",
            "address_2": "Suite 004",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "MA",
            "postal_code": "024764784",
            "country_code": "US",
            "telephone_number": "781-646-0500 x231",
            "fax_number": "781-646-7130",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KENNETH",
        "middle_name": "I",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2020-12-20",
        "certification_date": "2020-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "3882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Junibell Williams
• Khaleela Willingham, PT, DPT
• Leigh Wilmot
• Heather Wilson, M.ED, RDN, LDN
• Jayne Wilson, LICSW
• Winchester Chiropractic Center, LLC
• Winchester Hospital
• Winchester Hospital - Shields MRI LLC
• Winchester Physician Associates (Woburn Medical Associates)
• Winchester Physician Associates (Winchester Hospital Chiropractic Center)

• Clinical Psychologist in Woburn, MA
• Providers in Woburn, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.