Individual provider Active NPI

Lee R. Herringshaw, PSY.D.

  • Clinical Psychologist
  • Cambridge, MA
National Provider Identifier
1487710406
Registry record updated Nov 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
MA7383 Issued in MA
Practice address
1696 Massachusetts Ave
Suite #2
Cambridge, MA 02138-1803
Phone
(617) 501-4488
Fax
(617) 864-0538
NPI assigned
Dec 28, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 9, 2012

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Development & Aging Psychologist 103TA0700X MA7383 MA
Cognitive & Behavioral Psychologist 103TB0200X
Clinical Psychologist 103TC0700X MA7383 MA Primary
Psychologist 103T00000X MA7383 MA
Group Psychotherapy Psychologist 103TP2701X MA7383 MA
Psychologist 103T00000X

Addresses

Primary practice location

1696 Massachusetts Ave
Suite #2
Cambridge, MA 02138-1803

Mailing address

1696 Massachusetts Ave
Suite #2
Cambridge, MA 02138-1803
Phone (617) 501-4488

Other identifiers 2

IdentifierTypeStateIssuer
0000W05805OtherMABLUE CROSS BLUE SHIELD
0526568MedicaidMA

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
I20050328000012 MA Practitioner - Clinical Psychologist 8022064690 Practice locations: Cambridge, MA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1696 Massachusetts Ave
Suite 2
Cambridge, MA 02138-1803
Phone (617) 501-4488

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MA7383MAMDAdult Development & Aging Psychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352419200000",
    "number": "1487710406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1696 MASSACHUSETTS AVE",
            "address_2": "SUITE #2",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021381803",
            "telephone_number": "617-501-4488",
            "fax_number": "617-864-0538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1696 MASSACHUSETTS AVE",
            "address_2": "SUITE #2",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021381803",
            "telephone_number": "617-501-4488",
            "fax_number": "617-864-0538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERRINGSHAW",
        "first_name": "LEE",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-28",
        "last_updated": "2012-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "MA",
            "license": "MA7383",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "MA7383",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MA",
            "license": "MA7383",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "MA",
            "license": "MA7383",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0000W05805",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0526568",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cambridge, MA

Sources for this page

Verify at the official NPI Registry.