Active NPI
Jessica Miller, PH.D.
- Clinical Psychologist
- Cambridge, MA
National Provider Identifier
1396936266
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6262
- Practice address
- 140 Upland Rd
Cambridge, MA 02140-3623 - Phone
- (617) 864-5286
- NPI assigned
- Aug 6, 2007
- Last updated
- Oct 10, 2008
- Sex
- Female
- 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 | 6262 | MA | Primary |
Addresses
Primary practice location
140 Upland Rd
Cambridge, MA 02140-3623
Mailing address
19 Bellevue Ave
Cambridge, MA 02140-3634
Phone (617) 864-5286
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 1, 2024 through Dec 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6262 | MA | MD | Neurorehabilitation Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223596800000",
"number": "1396936266",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 BELLEVUE AVE",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021403634",
"telephone_number": "617-864-5286"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "140 UPLAND RD",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021403623",
"telephone_number": "617-864-5286"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "JESSICA",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-08-06",
"last_updated": "2008-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "6262",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cambridge, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2008; 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.