Active NPI
Carol Ann Ivan, PH.D.
- Clinical Psychologist
- Newton, MA
National Provider Identifier
1588745301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 7178
- Practice address
- 1400 Centre St
Suite 105
Newton, MA 02459-2454 - Phone
- (617) 964-0900
- Fax
- (617) 965-7979
- NPI assigned
- Oct 18, 2006
- 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 | 7178 | MA | Primary |
Addresses
Primary practice location
1400 Centre St
Suite 105
Newton, MA 02459-2454
Mailing address
PO Box 590354
Newton, MA 02459-0003
Phone (617) 964-0900
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| W05628 | Other | MA | BLUE CROSS BLUE SHIELD |
| 1850377 | Medicaid | MA |
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 |
|---|---|---|---|
| 7178 | MA | MD | Veterinarian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1588745301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 590354",
"city": "NEWTON",
"state": "MA",
"postal_code": "024590003",
"telephone_number": "617-964-0900",
"fax_number": "617-965-7979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 CENTRE ST",
"address_2": "SUITE 105",
"city": "NEWTON",
"state": "MA",
"postal_code": "024592454",
"telephone_number": "617-964-0900",
"fax_number": "617-965-7979"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IVAN",
"first_name": "CAROL",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "7178",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "W05628",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1850377",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.