Active NPI
Jennifer E. Gistrak, PSY.D.
- Psychologist
- Brookline, MA
National Provider Identifier
1205836673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 8415
- Practice address
- 1180 Beacon St
Suite 5C
Brookline, MA 02446-3885 - Phone
- (617) 335-5244
- NPI assigned
- Jul 28, 2005
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 8415 | MA | Primary |
Addresses
Primary practice location
1180 Beacon St
Suite 5C
Brookline, MA 02446-3885
Mailing address
1180 Beacon St
Suite 5C
Brookline, MA 02446-3885
Phone (617) 335-5244
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050817000769 | MA | Practitioner - Clinical Psychologist | 9638109846 | Practice locations: Cambridge, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
49 Hancock St
Cambridge, MA 02139-3188
Phone (617) 335-5244
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8415 | MA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1205836673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1180 BEACON ST",
"address_2": "SUITE 5C",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024463885",
"telephone_number": "617-335-5244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1180 BEACON ST",
"address_2": "SUITE 5C",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024463885",
"telephone_number": "617-335-5244"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GISTRAK",
"first_name": "JENNIFER",
"middle_name": "E.",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-07-28",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "8415",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brookline, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.