NPIMap

Organization Active NPI

Mda Wellness

  • Clinical Psychologist
  • Boston, MA
National Provider Identifier
1346097235
Registry record updated Apr 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
MDA WELLNESS
Practice address
111 Ocean St Apt 1
Boston, MA 02124-3626
Phone
(617) 249-3199
NPI assigned
Apr 30, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2024

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

Authorized official

Name
Marissa Alert, PHDNPI 1760905277
Title
Clinical Health Psychologist
Phone
(617) 249-3199

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

111 Ocean St Apt 1
Boston, MA 02124-3626

Mailing address

1 Washington Mall # 1261
Boston, MA 02108-2616

National Provider Directory

National Provider Directory

Locations

1 Washington Mall
#1261
Boston, MA 02108

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1714435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714435200000",
    "number": "1346097235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 WASHINGTON MALL # 1261",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021082616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 OCEAN ST APT 1",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021243626",
            "telephone_number": "617-249-3199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MDA WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-30",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A",
        "authorized_official_last_name": "ALERT",
        "authorized_official_first_name": "MARISSA",
        "authorized_official_title_or_position": "CLINICAL HEALTH PSYCHOLOGIST",
        "authorized_official_telephone_number": "617-249-3199",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.