Active NPI
Susan J. Lee, PSY.D.
- Clinical Psychologist
- Arlington, MA
National Provider Identifier
1295709020
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6759
- Practice address
- 259 Massachusetts Ave
Arlington, MA 02474-8406 - Phone
- (781) 696-9940
- Fax
- (866) 722-5733
- NPI assigned
- Feb 16, 2006
- Last updated
- Sep 15, 2008
- Sex
- Female
- 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 Psychologist | 103TC0700X | 6759 | MA | Primary |
Addresses
Primary practice location
259 Massachusetts Ave
Arlington, MA 02474-8406
Mailing address
354 Beaver St
Waltham, MA 02452-6232
Phone (781) 696-9940
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| W06221 | Other | MA | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20031104000041 | MA | Practitioner - Clinical Psychologist | 0840102364 | Practice locations: Concord, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
30 Domino Dr
Suite 2
Concord, MA 01742-2802
Phone (781) 696-9940
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6759 | MA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221436800000",
"number": "1295709020",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "354 BEAVER ST",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024526232",
"telephone_number": "781-696-9940",
"fax_number": "866-722-5733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "259 MASSACHUSETTS AVE",
"city": "ARLINGTON",
"state": "MA",
"postal_code": "024748406",
"telephone_number": "781-696-9940",
"fax_number": "866-722-5733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "SUSAN",
"middle_name": "J.",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-02-16",
"last_updated": "2008-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "6759",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "W06221",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Arlington, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.