Active NPI
Joao M. De Sa, PSYCHOLOGIST
- Clinical Psychologist
- Hubbardston, MA
National Provider Identifier
1356938336
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 7702
- Practice address
- 25 Bemis Rd
Hubbardston, MA 01452-1512 - Phone
- (978) 928-5261
- NPI assigned
- Dec 24, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 7702 | MA | |
| Clinical Psychologist | 103TC0700X | 7702 | MA | Primary |
Addresses
Primary practice location
25 Bemis Rd
Hubbardston, MA 01452-1512
Mailing address
25 Bemis Rd
Hubbardston, MA 01452-1512
Phone (978) 928-5261
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NONE | Medicaid | MA |
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 |
|---|---|---|---|
| 7702 | MA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1608768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1608768000000",
"number": "1356938336",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 BEMIS RD",
"city": "HUBBARDSTON",
"state": "MA",
"postal_code": "014521512",
"telephone_number": "978-928-5261"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 BEMIS RD",
"city": "HUBBARDSTON",
"state": "MA",
"postal_code": "014521512",
"telephone_number": "978-928-5261"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE SA",
"first_name": "JOAO",
"middle_name": "M.",
"name_prefix": "Dr.",
"credential": "PSYCHOLOGIST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-12-24",
"last_updated": "2020-12-24",
"certification_date": "2020-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "7702",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "7702",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "NONE",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hubbardston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.