Active NPI
Jesse Donald Kosiba, PH.D.
- Clinical Psychologist
- Newton, MA
National Provider Identifier
1760043632
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 11743
- Practice address
- 1075 Washington St
Newton, MA 02465-2185 - Phone
- (508) 876-7202
- NPI assigned
- Jun 21, 2019
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 11743 | MA | Primary |
Addresses
Primary practice location
1075 Washington St
Newton, MA 02465-2185
Mailing address
1075 Washington St
Newton, MA 02465-2185
Phone (508) 876-7202
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Aug 30, 2022 through Aug 30, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11743 | MA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708992000000",
"number": "1760043632",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1075 WASHINGTON ST",
"city": "NEWTON",
"state": "MA",
"postal_code": "024652185",
"telephone_number": "508-876-7202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1075 WASHINGTON ST",
"city": "NEWTON",
"state": "MA",
"postal_code": "024652185",
"telephone_number": "508-876-7202"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOSIBA",
"first_name": "JESSE",
"middle_name": "DONALD",
"name_prefix": "Mr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-06-21",
"last_updated": "2024-02-27",
"certification_date": "2024-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "11743",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.