Active NPI
Alice Diane Domar, PH.D.
- Cognitive & Behavioral Psychologist
- Waltham, MA
National Provider Identifier
1417902099
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cognitive & Behavioral Psychologist
- License
- 4308
- Practice address
- 130 2ND Ave
Boston Ivf - Domar Center
Waltham, MA 02451-1100 - Phone
- (781) 434-6578
- Fax
- (781) 370-2330
- NPI assigned
- May 23, 2006
- 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 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | 4308 | MA | Primary |
| Clinical Psychologist | 103TC0700X | 4308 | MA | |
| Counseling Psychologist | 103TC1900X | 4308 | MA | |
| Family Psychologist | 103TF0000X | 4308 | MA | |
| Health Service Psychologist | 103TH0100X | 4308 | MA | |
| Psychologist | 103T00000X | 4308 | MA | |
| Group Psychotherapy Psychologist | 103TP2701X | 4308 | MA |
Addresses
Primary practice location
130 2ND Ave
Boston Ivf - Domar Center
Waltham, MA 02451-1100
Mailing address
130 2ND Ave
Boston Ivf - Domar Center
Waltham, MA 02451-1100
Phone (781) 434-6578
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
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251763200000",
"number": "1417902099",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 2ND AVE",
"address_2": "BOSTON IVF - DOMAR CENTER",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024511100",
"telephone_number": "781-434-6578",
"fax_number": "781-370-2330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 2ND AVE",
"address_2": "BOSTON IVF - DOMAR CENTER",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024511100",
"telephone_number": "781-434-6578",
"fax_number": "781-370-2330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMAR",
"first_name": "ALICE",
"middle_name": "DIANE",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-23",
"last_updated": "2009-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "MA",
"license": "4308",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "4308",
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "MA",
"license": "4308",
"primary": false
},
{
"code": "103TF0000X",
"taxonomy_group": "",
"desc": "Psychologist, Family",
"state": "MA",
"license": "4308",
"primary": false
},
{
"code": "103TH0100X",
"taxonomy_group": "",
"desc": "Psychologist, Health Service",
"state": "MA",
"license": "4308",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "4308",
"primary": false
},
{
"code": "103TP2701X",
"taxonomy_group": "",
"desc": "Psychologist, Group Psychotherapy",
"state": "MA",
"license": "4308",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waltham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.