Active NPI
Brenda K Hawks, PHD
- Psychologist
- Waltham, MA
National Provider Identifier
1316080575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 4916
- Practice address
- 175 Forest St
Waltham, MA 02452 - Phone
- (781) 891-2265
- Fax
- (781) 891-2474
- NPI assigned
- Feb 15, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 4916 | MA | Primary |
Addresses
Primary practice location
175 Forest St
Waltham, MA 02452
Mailing address
PO Box 538
194 Orchard St
Belmont, MA 02478
Phone (617) 484-5804
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Aug 15, 2024 through Aug 15, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4916 | MA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1316080575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 538",
"address_2": "194 ORCHARD ST",
"city": "BELMONT",
"state": "MA",
"postal_code": "02478",
"telephone_number": "617-484-5804",
"fax_number": "781-891-2474"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "175 FOREST ST",
"city": "WALTHAM",
"state": "MA",
"postal_code": "02452",
"telephone_number": "781-891-2265",
"fax_number": "781-891-2474"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAWKS",
"first_name": "BRENDA",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "4916",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waltham, 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.