Active NPI
Harvey Irwin Botman, PH.D.
- Clinical Neuropsychologist
- Lexington, MA
National Provider Identifier
1275735557
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 4176
- Practice address
- Suite 3
15 Depot Square
Lexington, MA 02420-6330 - Phone
- (617) 429-1882
- NPI assigned
- May 31, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 4176 | MA | Primary |
Addresses
Primary practice location
Suite 3
15 Depot Square
Lexington, MA 02420-6330
Mailing address
4 Hayward Ave
Lexington, MA 02421-7211
Phone (781) 863-2612
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4176 | MA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1275735557",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4 HAYWARD AVE",
"city": "LEXINGTON",
"state": "MA",
"postal_code": "024217211",
"telephone_number": "781-863-2612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "SUITE 3",
"address_2": "15 DEPOT SQUARE",
"city": "LEXINGTON",
"state": "MA",
"postal_code": "024206330",
"telephone_number": "617-429-1882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOTMAN",
"first_name": "HARVEY",
"middle_name": "IRWIN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "MA",
"license": "4176",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lexington, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.