Active NPI
Dipti Mudgal, PHD
- Psychologist
- Brockton, MA
National Provider Identifier
1437381019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 8942
- Practice address
- 596 Summer St
Brockton, MA 02302 - Phone
- (508) 588-8800
- Fax
- (508) 588-4188
- NPI assigned
- Aug 17, 2009
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-09-5080 | ||
| Psychologist | 103T00000X | 8942 | MA | Primary |
Addresses
Primary practice location
596 Summer St
Brockton, MA 02302
Mailing address
37 Eames Way
Marshfield, MA 02050-6325
Phone (601) 310-5856
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8942 | MA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1250467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1526256000000",
"number": "1437381019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "37 EAMES WAY",
"city": "MARSHFIELD",
"state": "MA",
"postal_code": "020506325",
"telephone_number": "601-310-5856"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "596 SUMMER ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "02302",
"telephone_number": "508-588-8800",
"fax_number": "508-588-4188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUDGAL",
"first_name": "DIPTI",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-08-17",
"last_updated": "2018-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": "1-09-5080",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "8942",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.