NPIMap

Organization Active NPI

Center for Lifespan Development

  • Clinical Psychologist
  • Waban, MA
National Provider Identifier
1205965423
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
CENTER FOR LIFESPAN DEVELOPMENT
Practice address
91 Wyman St
Suite One
Waban, MA 02468-1529
Phone
(617) 969-7891
NPI assigned
Mar 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Samuel J. Moncata, PSY.D.NPI 1447326657
Title
President
Phone
(617) 969-7891

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

91 Wyman St
Suite One
Waban, MA 02468-1529

Mailing address

91 Wyman St
Suite One
Waban, MA 02468-1529
Phone (617) 969-7891

National Provider Directory

National Provider Directory

Locations

91 Wyman St
Ste 1
Waban, MA 02468
Phone (617) 969-7891

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205965423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "91 WYMAN ST",
            "address_2": "SUITE ONE",
            "city": "WABAN",
            "state": "MA",
            "postal_code": "024681529",
            "telephone_number": "617-969-7891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91 WYMAN ST",
            "address_2": "SUITE ONE",
            "city": "WABAN",
            "state": "MA",
            "postal_code": "024681529",
            "telephone_number": "617-969-7891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR LIFESPAN DEVELOPMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MONCATA",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-969-7891",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waban, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.