Individual provider Active NPI

Stephen Elliot Litwack, PHD

  • Psychologist
  • Brockton, MA
National Provider Identifier
1447359849
Registry record updated Jul 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PY2105PR Issued in MA
Practice address
1342 Belmont Street
Suite 103
Brockton, MA 02401
Phone
(508) 895-9393
NPI assigned
Sep 22, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 12, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PY2105PR MA Primary
Psychologist 103T00000X 202 MA

Addresses

Primary practice location

1342 Belmont Street
Suite 103
Brockton, MA 02401

Mailing address

1342 Belmont Street
Suite 103
Brockton, MA 02401
Phone (508) 895-9393

Other identifiers 2

IdentifierTypeStateIssuer
161283OtherMAGELLAN
W02296OtherBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101211000036 MA Practitioner - Clinical Psychologist 8123215548 Practice locations: Concord, MA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1575 Monument St
Concord, MA 01742-5325
Phone (978) 551-3866

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PY2105PRMAMDPsychologist
202MAMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Lyudmila Rakita M.D.,P.C. PastSince Jul 5, 2012 Accepting new patients

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": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278892800000",
    "number": "1447359849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1342 BELMONT STREET",
            "address_2": "SUITE 103",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "02401",
            "telephone_number": "508-895-9393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1342 BELMONT STREET",
            "address_2": "SUITE 103",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "02401",
            "telephone_number": "508-895-9393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LITWACK",
        "first_name": "STEPHEN",
        "middle_name": "ELLIOT",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-22",
        "last_updated": "2010-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MA",
            "license": "PY2105PR",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MA",
            "license": "202",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "161283",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "W02296",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

Verify at the official NPI Registry.