Active NPI
Luis Duque, NCSP
- School Psychologist
- West Roxbury, MA
National Provider Identifier
1356579932
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 377754
- Practice address
- 1212 VFW Pkwy
Suite # 19
West Roxbury, MA 02132-4309 - Phone
- (617) 970-3002
- NPI assigned
- Jun 23, 2009
- Sex
- Male
- 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 |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 377754 | MA | Primary |
Addresses
Primary practice location
1212 VFW Pkwy
Suite # 19
West Roxbury, MA 02132-4309
Mailing address
1212 VFW Parkway
Suite # 19
West Roxbury, MA 02132-4309
Phone (617) 970-3002
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38039 | Other | NCSP--NATIONALLY CERTIFIED SCHOOL PSYCHOLOGIST | |
| 377754 | Other | MA | DEPARTMENT OF EDUCATION--LIC SCH PSYCHOLOGIST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 377754 | MA | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245715200000",
"number": "1356579932",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1212 VFW PARKWAY",
"address_2": "SUITE # 19",
"city": "WEST ROXBURY",
"state": "MA",
"postal_code": "021324309",
"telephone_number": "617-970-3002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1212 VFW PKWY",
"address_2": "SUITE # 19",
"city": "WEST ROXBURY",
"state": "MA",
"postal_code": "021324309",
"telephone_number": "617-970-3002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUQUE",
"first_name": "LUIS",
"credential": "NCSP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-06-23",
"last_updated": "2009-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "MA",
"license": "377754",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCSP--NATIONALLY CERTIFIED SCHOOL PSYCHOLOGIST",
"identifier": "38039",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPARTMENT OF EDUCATION--LIC SCH PSYCHOLOGIST",
"identifier": "377754",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Roxbury, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.