Active NPI
Kevin J Witham, PH.D.
- Clinical Psychologist
- Woburn, MA
National Provider Identifier
1437202306
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 8413
- Practice address
- 12 Alfred St
Suite 200
Woburn, MA 01801-1915 - Phone
- (781) 646-0500
- Fax
- (781) 646-7130
- NPI assigned
- Jan 22, 2007
- Sex
- Male
- Sole proprietor
- No
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 | 8413 | MA | Primary |
Addresses
Primary practice location
12 Alfred St
Suite 200
Woburn, MA 01801-1915
Mailing address
12 Alfred St
Suite 200
Woburn, MA 01801-1915
Phone (781) 646-0500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8413 | Other | MA | LICENSE |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1437202306",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 ALFRED ST",
"address_2": "SUITE 200",
"city": "WOBURN",
"state": "MA",
"postal_code": "018011915",
"telephone_number": "781-646-0500",
"fax_number": "781-646-7130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 ALFRED ST",
"address_2": "SUITE 200",
"city": "WOBURN",
"state": "MA",
"postal_code": "018011915",
"telephone_number": "781-646-0500",
"fax_number": "781-646-7130"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITHAM",
"first_name": "KEVIN",
"middle_name": "J",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "8413",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "8413",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.