Active NPI
Julie M Mack, PHD PSYCHOLOGY
- Clinical Psychologist
- Hanover, MA
National Provider Identifier
1306912415
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3679
- Practice address
- 24 Rockland St
Unit 7 Hanover Psychological Associates
Hanover, MA 02339-2226 - Phone
- (781) 826-8228
- Fax
- (781) 826-0965
- NPI assigned
- Nov 28, 2006
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 3769 | MA | |
| Clinical Psychologist | 103TC0700X | 3679 | MA | Primary |
| Forensic Psychologist | 103TF0200X | 3769 | MA | |
| Cognitive & Behavioral Psychologist | 103TB0200X | B769 | MA |
Addresses
Primary practice location
24 Rockland St
Unit 7 Hanover Psychological Associates
Hanover, MA 02339-2226
Mailing address
24 Rockland St
Unit 7 Hanover Psychological Associates
Hanover, MA 02339-2226
Phone (781) 826-8228
Other identifiers 12
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0515299 | Medicaid | MA | |
| 6151458 | Other | UNITED | |
| 4545006 | Other | AETNA | |
| 000821 | Other | VALUE OPTIONS | |
| 3249700821 | Other | HARVARD PILGRIM | |
| 703727 | Other | 1ST HEALTH | |
| 009484 | Other | TRICARE | |
| 1007070 | Other | BEACON HEALTH | |
| 202886 | Other | MHN | |
| M62937 | Other | 1ST SENIORITY | |
| 111631000 | Other | MAGELLAN | |
| 767861 | Other | TUFTS |
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 |
|---|---|---|---|---|
| I20120203000498 | MA | Practitioner - Clinical Psychologist | 0648437525 | Practice locations: Hanover, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
24 Rockland St
Hanover, MA 02339-2226
Phone 78182682281
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| B769 | MA | MD | Cognitive & Behavioral Psychologist |
| 3679 | MA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317254400000",
"number": "1306912415",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24 ROCKLAND ST",
"address_2": "UNIT 7 HANOVER PSYCHOLOGICAL ASSOCIATES",
"city": "HANOVER",
"state": "MA",
"postal_code": "023392226",
"telephone_number": "781-826-8228",
"fax_number": "781-826-0965"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24 ROCKLAND ST",
"address_2": "UNIT 7 HANOVER PSYCHOLOGICAL ASSOCIATES",
"city": "HANOVER",
"state": "MA",
"postal_code": "023392226",
"telephone_number": "781-826-8228",
"fax_number": "781-826-0965"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "JULIE",
"middle_name": "M",
"credential": "PHD PSYCHOLOGY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-28",
"last_updated": "2011-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "MA",
"license": "3769",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "3679",
"primary": true
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "MA",
"license": "3769",
"primary": false
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "MA",
"license": "B769",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0515299",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED",
"identifier": "6151458",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4545006",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "000821",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "3249700821",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "1ST HEALTH",
"identifier": "703727",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "009484",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BEACON HEALTH",
"identifier": "1007070",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHN",
"identifier": "202886",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "1ST SENIORITY",
"identifier": "M62937",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "111631000",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "767861",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Hanover, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2011; 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.