Individual provider Active NPI

Elizabeth Mary Waldron, PHD

  • Psychologist
  • Boston, MA
National Provider Identifier
1316685779
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY10000466 Issued in MA
Practice address
55 Fruit St
Boston, MA 02114-2621
Phone
(617) 724-5600
NPI assigned
May 25, 2022
Last updated
Oct 17, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSY10000466 MA Primary

Addresses

Primary practice location

55 Fruit St
Boston, MA 02114-2621

Mailing address

1 Bowdoin St Ste 900
Boston, MA 02114-4201
Phone (617) 724-6521

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241030004175 MA Practitioner - Clinical Psychologist 1254864143 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

50 Staniford St
Boston, MA 02114-2517

55 Fruit St
Boston, MA 02114-2696
Phone (617) 724-0287

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PSY10000466MAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
General Hospital Corp Current Accepting new patients
The General Hospital Corporation CurrentSince Nov 1, 2024 Accepting new patients
Massachusetts General Physicians Organization Inc CurrentSince Nov 1, 2024 Accepting new patients

Locations

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

55 Fruit St
Boston, MA 02114

62 13th St
Charlestown, MA 02129
Phone (617) 724-3874

Interoperability endpoints

  • Direct secure messaging: waldron.elizabeth.mgh@direct.partners.masshiway.net

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1653436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1316685779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BOWDOIN ST STE 900",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021144201",
            "telephone_number": "617-724-6521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142621",
            "telephone_number": "617-724-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDRON",
        "first_name": "ELIZABETH",
        "middle_name": "MARY",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-25",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MA",
            "license": "PSY10000466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.