Active NPI
Mark Loesch, PH.D.
- Psychologist
- Boston, MA
National Provider Identifier
1215357587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 75 State St FL 26
Boston, MA 02109-1827 - Phone
- (617) 204-3500
- NPI assigned
- Apr 24, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 29157 | CA | |
| Psychologist | 103T00000X | CA | Primary |
Addresses
Primary practice location
75 State St FL 26
Boston, MA 02109-1827
Mailing address
1840 S Gaffey St
# 44
San Pedro, CA 90731-5324
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29157 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1398297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1645488000000",
"number": "1215357587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1840 S GAFFEY ST",
"address_2": "# 44",
"city": "SAN PEDRO",
"state": "CA",
"postal_code": "907315324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 STATE ST FL 26",
"city": "BOSTON",
"state": "MA",
"postal_code": "021091827",
"telephone_number": "617-204-3500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOESCH",
"first_name": "MARK",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-04-24",
"last_updated": "2022-02-22",
"certification_date": "2022-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "29157",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.