Active NPI
Brenda Pollara Black, PH.D.
- Clinical Psychologist
- Hingham, MA
National Provider Identifier
1578619201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 4444
- Practice address
- 12 Whitcomb Ave
Hingham, MA 02043-3385 - Phone
- (781) 740-1128
- Fax
- (781) 740-1320
- NPI assigned
- Jan 26, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 4444 | MA | Primary |
Addresses
Primary practice location
12 Whitcomb Ave
Hingham, MA 02043-3385
Mailing address
12 Whitcomb Ave
Hingham, MA 02043-3385
Phone (781) 740-1128
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 22, 2021 through Feb 22, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4444 | MA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1578619201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 WHITCOMB AVE",
"city": "HINGHAM",
"state": "MA",
"postal_code": "020433385",
"telephone_number": "781-740-1128",
"fax_number": "781-740-1320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 WHITCOMB AVE",
"city": "HINGHAM",
"state": "MA",
"postal_code": "020433385",
"telephone_number": "781-740-1128",
"fax_number": "781-740-1320"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "BRENDA",
"middle_name": "POLLARA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "4444",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hingham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.