Active NPI
Laura Theodor Shibles, PHD
- Clinical Psychologist
- Newton, MA
National Provider Identifier
1538110614
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 7026
- Practice address
- 10 Langley Rd
Ste 300
Newton, MA 02459-1972 - Phone
- (800) 370-3651
- Fax
- (860) 510-0020
- NPI assigned
- May 13, 2006
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 7026 | MA | |
| Clinical Psychologist | 103TC0700X | 7026 | MA | Primary |
| Clinical Psychologist | 103TC0700X | 009601 | NY |
Addresses
Primary practice location
10 Langley Rd
Ste 300
Newton, MA 02459-1972
Mailing address
20 Research Pkwy
Suite C
Old Saybrook, CT 06475-4214
Phone (800) 370-3651
Other names 1
- Laura Theodor
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7026 | MA | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medoptions of Massachusetts LLC | Clinical | Past | Accepting new patients |
| Cape Cod Healthcare Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Hyannis, MA
- NPI 1245286152
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260835200000",
"number": "1538110614",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 RESEARCH PKWY",
"address_2": "SUITE C",
"city": "OLD SAYBROOK",
"state": "CT",
"postal_code": "064754214",
"telephone_number": "800-370-3651",
"fax_number": "860-510-0020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 LANGLEY RD",
"address_2": "STE 300",
"city": "NEWTON",
"state": "MA",
"postal_code": "024591972",
"telephone_number": "800-370-3651",
"fax_number": "860-510-0020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THEODOR SHIBLES",
"first_name": "LAURA",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-13",
"last_updated": "2009-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "7026",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "7026",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "009601",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "LAURA",
"last_name": "THEODOR",
"credential": "PHD",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Newton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.