Active NPI
Mary Ellis, PSYD
- Psychologist
- Boston, MA
National Provider Identifier
1720594088
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 11988
- Practice address
- 7 Drydock Ave Ste 2070
Boston, MA 02210-2303 - Phone
- (857) 203-6461
- NPI assigned
- Dec 22, 2017
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 11988 | MA | Primary |
Addresses
Primary practice location
7 Drydock Ave Ste 2070
Boston, MA 02210-2303
Mailing address
3640 Colonel Glenn Hwy
Dayton, OH 45435-0001
Phone (937) 775-3458
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 |
|---|---|---|---|
| 11988 | MA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687305600000",
"number": "1720594088",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3640 COLONEL GLENN HWY",
"city": "DAYTON",
"state": "OH",
"postal_code": "454350001",
"telephone_number": "937-775-3458",
"fax_number": "937-775-3434"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7 DRYDOCK AVE STE 2070",
"city": "BOSTON",
"state": "MA",
"postal_code": "022102303",
"telephone_number": "857-203-6461"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "MARY",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-12-22",
"last_updated": "2023-06-21",
"certification_date": "2023-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "11988",
"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 Jun 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.