NPIMap

Organization Active NPI

Octave Behavioral, PA

  • Psychologist
  • Boston, MA
National Provider Identifier
1508610775
Registry record updated Jun 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
OCTAVE BEHAVIORAL, PA
Practice address
84 State St
Boston, MA 02109-2202
Phone
(415) 360-3833
Fax
(628) 234-3048
NPI assigned
Apr 15, 2024
Last updated
Jun 27, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2025

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

Authorized official

Name
Kym Everett
Title
VP, Revenue Operations
Phone
(650) 504-2289

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

84 State St
Boston, MA 02109-2202

Mailing address

625 Market St FL 15
San Francisco, CA 94105-3316
Phone (415) 360-3833

Other practice location 1

1934 Lakeview Ave Ste 622A
Dracut, MA 01826-3278
Phone (415) 360-3833

Other practice location 2

16 Anderson St
Marblehead, MA 01945-2487
Phone (415) 360-3833

National Provider Directory

National Provider Directory
Tax ID family
Octave Behavioral PA11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1934 Lakeview Ave
Ste 622A
Dracut, MA 01826
Phone (978) 419-1957

16 Anderson St
Marblehead, MA 01945
Phone (781) 309-7715

NPI Registry JSON

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

{
    "created_epoch": "1713139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750982400000",
    "number": "1508610775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 MARKET ST FL 15",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941053316",
            "telephone_number": "415-360-3833",
            "fax_number": "628-234-3048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "84 STATE ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021092202",
            "telephone_number": "415-360-3833",
            "fax_number": "628-234-3048"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1934 Lakeview Ave Ste 622A",
            "address_purpose": "LOCATION",
            "city": "Dracut",
            "state": "MA",
            "postal_code": "018263278",
            "country_code": "US",
            "telephone_number": "415-360-3833",
            "fax_number": "628-234-3048",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16 Anderson St",
            "address_purpose": "LOCATION",
            "city": "Marblehead",
            "state": "MA",
            "postal_code": "019452487",
            "country_code": "US",
            "telephone_number": "415-360-3833",
            "fax_number": "628-234-3048",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OCTAVE BEHAVIORAL, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-15",
        "last_updated": "2025-06-27",
        "certification_date": "2025-06-27",
        "status": "A",
        "authorized_official_last_name": "EVERETT",
        "authorized_official_first_name": "KYM",
        "authorized_official_title_or_position": "VP, REVENUE OPERATIONS",
        "authorized_official_telephone_number": "650-504-2289"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.