NPIMap

Organization Active NPI

Boston Neuropsychological Services, LLC

  • Clinical Neuropsychologist
  • Needham, MA
National Provider Identifier
1407048432
Registry record updated May 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
Legal business name
BOSTON NEUROPSYCHOLOGICAL SERVICES, LLC
Practice address
687 Highland Avenue
2ND Floor
Needham, MA 02494
Phone
(781) 559-8444
Fax
(781) 559-8117
NPI assigned
Aug 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kevin A Domingos, PH.D.NPI 1770662173
Title
Clinical Director
Phone
(781) 559-8444

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X Primary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X

Addresses

Primary practice location

687 Highland Avenue
2ND Floor
Needham, MA 02494

Mailing address

687 Highland Avenue
2ND Floor
Needham, MA 02494-2409
Phone (781) 559-8444

Other identifiers 1

IdentifierTypeStateIssuer
W10647OtherMABLUE CROSS/BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090304000750 MA Part B Supplier - Clinic/Group Practice 2668538794 Receives reassigned benefits from 14 practitioners
Practice locations: Needham, MA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559088000000",
    "number": "1407048432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "687 HIGHLAND AVENUE",
            "address_2": "2ND FLOOR",
            "city": "NEEDHAM",
            "state": "MA",
            "postal_code": "024942409",
            "telephone_number": "781-559-8444",
            "fax_number": "781-559-8117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "687 HIGHLAND AVENUE",
            "address_2": "2ND FLOOR",
            "city": "NEEDHAM",
            "state": "MA",
            "postal_code": "02494",
            "telephone_number": "781-559-8444",
            "fax_number": "781-559-8117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON NEUROPSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-14",
        "last_updated": "2019-05-29",
        "status": "A",
        "authorized_official_last_name": "DOMINGOS",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "781-559-8444",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "W10647",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Needham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.