Active NPI
Mira Mooreville Nurko, PSYD
- Psychologist
- Boston, MA
National Provider Identifier
1356824288
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 11212
- Practice address
- 71 Rockview St
Boston, MA 02130-2147 - Phone
- (610) 304-9072
- NPI assigned
- Sep 6, 2018
- 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 | 11212 | MA | Primary |
Addresses
Primary practice location
71 Rockview St
Boston, MA 02130-2147
Mailing address
71 Rockview St
Boston, MA 02130-2147
Phone (610) 304-9072
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 2, 2025 through Apr 2, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11212 | MA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575331200000",
"number": "1356824288",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "71 ROCKVIEW ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021302147",
"telephone_number": "610-304-9072"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "71 ROCKVIEW ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021302147",
"telephone_number": "610-304-9072"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NURKO",
"first_name": "MIRA",
"middle_name": "MOOREVILLE",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-06",
"last_updated": "2019-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "11212",
"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 Dec 3, 2019; 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.