Active NPI
Tracy H Heibeck, PH.D.
- Clinical Child & Adolescent Psychologist
- Lexington, MA
National Provider Identifier
1720224397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 5012
- Practice address
- 46 Meriam St
Lexington, MA 02420-3620 - Phone
- (781) 863-5760
- NPI assigned
- Jan 1, 2009
- 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 Child & Adolescent Psychologist | 103TC2200X | 5012 | MA | Primary |
Addresses
Primary practice location
46 Meriam St
Lexington, MA 02420-3620
Mailing address
46 Meriam St
Lexington, MA 02420-3620
Phone (781) 863-5760
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5012 | MA | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1230768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1230768000000",
"number": "1720224397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "46 MERIAM ST",
"city": "LEXINGTON",
"state": "MA",
"postal_code": "024203620",
"telephone_number": "781-863-5760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "46 MERIAM ST",
"city": "LEXINGTON",
"state": "MA",
"postal_code": "024203620",
"telephone_number": "781-863-5760"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEIBECK",
"first_name": "TRACY",
"middle_name": "H",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-01-01",
"last_updated": "2009-01-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MA",
"license": "5012",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lexington, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.