Jacob Luke Varela, PSYD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PS02308 Issued in RI

Practice address

345 Blackstone Blvd Ste 2
Providence, RI 02906-4829

Phone

(844) 401-0111

NPI assigned

Jan 8, 2025

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in RI

Eligible to order & refer

• Part B services: No
• 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

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 and National Provider Directory roles.

• Affinity Physicians LLC.

  • Internal Medicine Physician
  • Warwick, RI
  • NPI 1184944662

  Clinical Neuropsychologist

  Medicare reassignment NPD
• Affinity Physicians LLC

  • Anesthesiology Physician
  • Providence, RI
  • NPI 1053038471
  NPD

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

{
    "created_epoch": "1736294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750118400000",
    "number": "1699585190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 TOLL GATE RD",
            "address_2": "PRC AND CREDENTIALING",
            "city": "WARWICK",
            "state": "RI",
            "postal_code": "028862759",
            "telephone_number": "401-273-0641",
            "fax_number": "401-273-2919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 BLACKSTONE BLVD STE 2",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029064829",
            "telephone_number": "844-401-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VARELA",
        "first_name": "JACOB",
        "middle_name": "LUKE",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-01-08",
        "last_updated": "2025-06-17",
        "certification_date": "2025-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "RI",
            "license": "PS02308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beth Vanpraag, CRNA
• Paul E.a. Vanzuiden, MD
• Maham Vaqar, M.B.,B.S.
• Vincent Michael Varamo, DO
• Kalya Vardi, M.D.
• Sean Varga, MD
• Leslie Annette Vargas Galvan, MD
• Ysmabel Vargas
• Laura Varghese, M.D.
• Erin Rose Variano, MS, ATC

• Clinical Neuropsychologist in Providence, RI
• Providers in Providence, RI by specialty
• Clinical Neuropsychologist in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2025; 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.