Active NPI
Mark Centrella, PSY.D.
- Clinical Psychologist
- Belmont, MA
National Provider Identifier
1396717880
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6129
- Practice address
- 115 Mill St
Belmont, MA 02478-1041 - Phone
- (617) 855-3674
- Fax
- (617) 855-3826
- NPI assigned
- Feb 7, 2006
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6129 | MA | Primary |
Addresses
Primary practice location
115 Mill St
Belmont, MA 02478-1041
Mailing address
76 Baker St
Belmont, MA 02478-4025
Phone (617) 489-2794
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
115 Mill St
Belmont, MA 02478-1064
Phone (617) 855-3450
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6129 | MA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The McLean Hospital Corporation | Clinical | Current | Accepting new patients |
Locations
115 Mill St
Rm 321
Belmont, MA 02478
Phone (617) 855-3674
115 Mill St
Belmont, MA 02478
Phone (617) 855-2000
Interoperability endpoints
- centrella.mark.mcl@direct.partners.masshiway.net
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316995200000",
"number": "1396717880",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "76 BAKER ST",
"city": "BELMONT",
"state": "MA",
"postal_code": "024784025",
"telephone_number": "617-489-2794",
"fax_number": "617-855-3826"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 MILL ST",
"city": "BELMONT",
"state": "MA",
"postal_code": "024781041",
"telephone_number": "617-855-3674",
"fax_number": "617-855-3826"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CENTRELLA",
"first_name": "MARK",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-02-07",
"last_updated": "2011-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "6129",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Belmont, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.