NPIMap

Individual provider Active NPI

Shawna E Boles, PSY.D

  • Clinical Psychologist
  • Dorchester, MA
National Provider Identifier
1225359201
Registry record updated Mar 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
9700 Issued in MA
Practice address
425 Harvard Street
Dorchester, MA 02124
Phone
(617) 740-0116
Fax
(413) 739-9972
NPI assigned
Jun 14, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X
Clinical Psychologist 103TC0700X 9700 MA Primary

Addresses

Primary practice location

425 Harvard Street
Dorchester, MA 02124

Mailing address

425 Harvard Street
Dorchester, MA 02124
Phone (617) 740-0116

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
9700MAMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1276473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519862400000",
    "number": "1225359201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 HARVARD STREET",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "02124",
            "telephone_number": "617-740-0116",
            "fax_number": "413-739-9972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 HARVARD STREET",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "02124",
            "telephone_number": "617-740-0116",
            "fax_number": "413-739-9972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLES",
        "first_name": "SHAWNA",
        "middle_name": "E",
        "credential": "PSY.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-14",
        "last_updated": "2018-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "9700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dorchester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2018; 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.