Active NPI
Karen J Kaczynski, PHD
- Clinical Child & Adolescent Psychologist
- Waltham, MA
National Provider Identifier
1700036738
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 8915
- Practice address
- 9 Hope Ave
Headache Clinic
Waltham, MA 02453-2741 - Phone
- (617) 355-8104
- Fax
- (617) 730-0199
- NPI assigned
- Sep 26, 2008
- 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 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | |||
| Cognitive & Behavioral Psychologist | 103TB0200X | 8915 | MA | |
| Clinical Psychologist | 103TC0700X | 8915 | MA | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 8915 | MA | Primary |
| Health Psychologist | 103TH0004X | 8915 | MA |
Addresses
Primary practice location
9 Hope Ave
Headache Clinic
Waltham, MA 02453-2741
Mailing address
333 Longwood Ave
5TH Floor
Boston, MA 02115-5711
Phone (617) 355-8104
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 |
|---|---|---|---|
| 8915 | MA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222387200000",
"number": "1700036738",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "333 LONGWOOD AVE",
"address_2": "5TH FLOOR",
"city": "BOSTON",
"state": "MA",
"postal_code": "021155711",
"telephone_number": "617-355-8104",
"fax_number": "617-730-0199"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9 HOPE AVE",
"address_2": "HEADACHE CLINIC",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024532741",
"telephone_number": "617-355-8104",
"fax_number": "617-730-0199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KACZYNSKI",
"first_name": "KAREN",
"middle_name": "J",
"name_prefix": "Ms.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-09-26",
"last_updated": "2008-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "MA",
"license": "8915",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "8915",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MA",
"license": "8915",
"primary": true
},
{
"code": "103TH0004X",
"taxonomy_group": "",
"desc": "Psychologist, Health",
"state": "MA",
"license": "8915",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waltham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.