Sucheta Thekkedam, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

10481 Issued in MA

Practice address

85 E Newton St
912
Boston, MA 02118-2340

Phone

(617) 414-4646

NPI assigned

Sep 14, 2012

Last updated

May 16, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• SSM Cardinal Glennon Childrens Hospital

  dba SSM Health Cardinal Glennon Children's Hospital

  • Pediatrics Physician
  • O'Fallon, IL
  • NPI 1174577670

  MO

  Medicare reassignment NPD
• SSM Cardinal Glennon Children's Hospital

  dba SSM Health Cardinal Glennon Pediatrics

  • Pediatrics Physician
  • Warrenton, MO
  • NPI 1962573212
  NPD

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

{
    "created_epoch": "1347580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494892800000",
    "number": "1639429897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 AMERICAN LEGION HWY",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021313908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 E NEWTON ST",
            "address_2": "912",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182340",
            "telephone_number": "617-414-4646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEKKEDAM",
        "first_name": "SUCHETA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-14",
        "last_updated": "2017-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "10481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Martha A Theirl, PT, DPT
• Jesse Theisen-Toupal, M.D.
• Erin Marie Theisen, MD, PHD
• Mandy B Theisen, AU.D., CCC-A
• Thekey of Massachusetts, LLC
• Susan P. Thel, M.S.W.
• Maria D Theodorakakis, PHD
• Arthur C. Theodore, M.D.
• George H Theodore, M.D.
• Miranda Theodore, MD

• Clinical Psychologist in Boston, MA
• Providers in Boston, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.