Active NPI
Carol Peacock, PH.D.
- Clinical Psychologist
- Cambridge, MA
National Provider Identifier
1720139165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3952
- Practice address
- 158 Mount Auburn St
Ste 2
Cambridge, MA 02138-4876 - Phone
- (617) 547-6200
- Fax
- (617) 527-3288
- NPI assigned
- Jan 14, 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3952 | MA | Primary |
Addresses
Primary practice location
158 Mount Auburn St
Ste 2
Cambridge, MA 02138-4876
Mailing address
32 Fern St
Auburndale, MA 02466-2207
Phone (617) 547-6200
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 |
|---|---|---|---|---|
| I20120227000218 | MA | Practitioner - Clinical Psychologist | 7214195957 | Practice locations: Auburndale, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
32 Fern St
Auburndale, MA 02466-2207
Phone (617) 862-6466
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3952 | MA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465171200000",
"number": "1720139165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "32 FERN ST",
"city": "AUBURNDALE",
"state": "MA",
"postal_code": "024662207",
"telephone_number": "617-547-6200",
"fax_number": "617-547-4884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "158 MOUNT AUBURN ST",
"address_2": "STE 2",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021384876",
"telephone_number": "617-547-6200",
"fax_number": "617-527-3288"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEACOCK",
"first_name": "CAROL",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-14",
"last_updated": "2016-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "3952",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cambridge, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2016; 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.