Active NPI
Mia Medina, PSY.D.
- Psychologist
- Boston, MA
National Provider Identifier
1710179320
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 8737
- Practice address
- 186 Beacon St
Boston, MA 02116-1342 - Phone
- (617) 983-7346
- NPI assigned
- Aug 16, 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 8737 | MA | Primary |
Addresses
Primary practice location
186 Beacon St
Boston, MA 02116-1342
Mailing address
186 Beacon St
Boston, MA 02116-1342
Phone (617) 983-7346
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8737 | MA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187222400000",
"number": "1710179320",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "186 BEACON ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021161342",
"telephone_number": "617-983-7346"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "186 BEACON ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021161342",
"telephone_number": "617-983-7346"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "MIA",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-08-16",
"last_updated": "2007-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "8737",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 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.