Active NPI
Meredith Anne Shaw, PH.D.
- Clinical Psychologist
- Brockton, MA
National Provider Identifier
1437409190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 36250
- Practice address
- 940 Belmont St
Brockton, MA 02301-5596 - Phone
- (774) 826-1969
- Fax
- (774) 826-3159
- NPI assigned
- Sep 10, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 36250 | TX | Primary |
Addresses
Primary practice location
940 Belmont St
Brockton, MA 02301-5596
Mailing address
20 Commerce Way Ste 10-343
Seekonk, MA 02771-5823
Phone (817) 366-2130
Other practice location 1
20 Commerce Way Ste 10-343
Seekonk, MA 02771-5823
Phone (774) 565-4310
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260608002117 | TX | Practitioner - Clinical Psychologist | 5294206561 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
20 Commerce Way
Suite 343
Seekonk, MA 02771-5823
708 Main St
FL 4
Houston, TX 77002-0001
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36250 | TX | MD | Clinical Psychologist |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689206400000",
"number": "1437409190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 COMMERCE WAY STE 10-343",
"city": "SEEKONK",
"state": "MA",
"postal_code": "027715823",
"telephone_number": "817-366-2130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "940 BELMONT ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023015596",
"telephone_number": "774-826-1969",
"fax_number": "774-826-3159"
}
],
"practiceLocations": [
{
"address_1": "20 Commerce Way Ste 10-343",
"address_purpose": "LOCATION",
"city": "Seekonk",
"state": "MA",
"postal_code": "027715823",
"country_code": "US",
"telephone_number": "774-565-4310",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHAW",
"first_name": "MEREDITH",
"middle_name": "ANNE",
"name_prefix": "Ms.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-10",
"last_updated": "2023-07-13",
"certification_date": "2023-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "36250",
"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 Jul 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.