Active NPI
Jenice Amy Ely, PH.D.
- Clinical Psychologist
- Lexington, MA
National Provider Identifier
1467409839
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6930
- Practice address
- 4 Militia Dr
Suite 15
Lexington, MA 02421-4737 - Phone
- (781) 674-1121
- Fax
- (781) 674-1121
- NPI assigned
- May 30, 2006
- Last updated
- Jul 13, 2026
- 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 |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 6930 | MA | |
| Clinical Psychologist | 103TC0700X | 6930 | MA | Primary |
Addresses
Primary practice location
4 Militia Dr
Suite 15
Lexington, MA 02421-4737
Mailing address
23 Fair Oaks Ter
Lexington, MA 02421-6905
Phone (781) 863-9518
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 |
|---|---|---|---|
| 6930 | MA | MD | Clinical Neuropsychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1467409839",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23 FAIR OAKS TER",
"city": "LEXINGTON",
"state": "MA",
"postal_code": "024216905",
"telephone_number": "781-863-9518",
"fax_number": "781-674-1121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4 MILITIA DR",
"address_2": "SUITE 15",
"city": "LEXINGTON",
"state": "MA",
"postal_code": "024214737",
"telephone_number": "781-674-1121",
"fax_number": "781-674-1121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELY",
"first_name": "JENICE",
"middle_name": "AMY",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-30",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "MA",
"license": "6930",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "6930",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lexington, MA
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- Eleanor Gardner Elkin, LICSW
- Madeline Elizabeth Ellis
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- Lauren Emery
- Empowered Behavioral Health, LLC
- Empowering Communication, LLC
- Endodontic Associates of Lexington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.