Active NPI
Brenda J King, PSYD
- Clinical Psychologist
- Worcester, MA
National Provider Identifier
1619201704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 10249
- Practice address
- 78 Burncoat Street
Worcester, MA 01605 - Phone
- (508) 471-1765
- NPI assigned
- Sep 23, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 10249 | MA | Primary |
Addresses
Primary practice location
78 Burncoat Street
Worcester, MA 01605
Mailing address
298 N Main St Unit 417
North Uxbridge, MA 01538-0620
Phone (508) 471-1765
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7157 | Other | MA | LICENSE |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160726000331 | MA | Practitioner - Clinical Psychologist | 9931492188 | Practice locations: Douglas, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
Douglas, MA 01516
Phone (508) 471-1765
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597104000000",
"number": "1619201704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "298 N MAIN ST UNIT 417",
"city": "NORTH UXBRIDGE",
"state": "MA",
"postal_code": "015380620",
"telephone_number": "508-471-1765"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "78 BURNCOAT STREET",
"city": "WORCESTER",
"state": "MA",
"postal_code": "01605",
"telephone_number": "508-471-1765"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KING",
"first_name": "BRENDA",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-09-23",
"last_updated": "2020-08-11",
"certification_date": "2020-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "10249",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "7157",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.