NPIMap

Individual provider Active NPI

Monica Tam Ly, PHD

  • Clinical Neuropsychologist
  • Boston, MA
National Provider Identifier
1295410157
Registry record updated Jun 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
PSY10000160 Issued in MA
Practice address
725 Albany Street, Suite 7B
Shapiro BLDG
Boston, MA 02118
Phone
(617) 638-8456
Fax
(617) 638-8465
NPI assigned
Jun 19, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X PSY10000160 MA Primary

Addresses

Primary practice location

725 Albany Street, Suite 7B
Shapiro BLDG
Boston, MA 02118

Mailing address

960 Massachusetts Avenue
FL 2
Boston, MA 02118-3021

Other practice location 1

The Stetson Building 541 Main Street
Suite 317
S. Weymouth, MA 02190
Phone (617) 638-9944

Other identifiers 2

IdentifierTypeStateIssuer
110206585AMedicaidMA
3143472MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231213000610 MA Practitioner - Clinical Psychologist 8820447071 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Boston University Neurology Associates IncGroup PAC ID 6608772462, 60 clinicians

Practice addresses (Care Compare)

725 Albany St
Suite 7B
Boston, MA 02118-3549
Phone (617) 638-8456

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY10000160MAMDClinical Neuropsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Boston University Neurology Associates, Inc. CurrentSince Nov 6, 2023 Accepting new patients
Boston Medical Center Corporation Current Accepting new patients

Locations

960 Massachusetts Ave
Ste 2
Boston, MA 02118

725 Albany St
Ste 7
Boston, MA 02118
Phone (617) 638-8456

725 Albany St
Ste 7B
Boston, MA 02118
Phone (617) 638-7490

541 Main St
Ste 317
Weymouth, MA 02190
Phone (617) 638-9944

Interoperability endpoints

  • Direct secure messaging: mly237949@direct.bmc.masshiway.net

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1687132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717977600000",
    "number": "1295410157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 MASSACHUSETTS AVENUE",
            "address_2": "FL 2",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021183021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 ALBANY STREET, SUITE 7B",
            "address_2": "SHAPIRO BLDG",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02118",
            "telephone_number": "617-638-8456",
            "fax_number": "617-638-8465"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "The Stetson Building 541 Main Street",
            "address_2": "Suite 317",
            "address_purpose": "LOCATION",
            "city": "S. Weymouth",
            "state": "MA",
            "postal_code": "02190",
            "country_code": "US",
            "telephone_number": "617-638-9944",
            "fax_number": "781-337-2891",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LY",
        "first_name": "MONICA",
        "middle_name": "TAM",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-19",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MA",
            "license": "PSY10000160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110206585A",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3143472",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.