Individual provider Active NPI

Tiffany R Glynn, PHD

  • Clinical Psychologist
  • Boston, MA
National Provider Identifier
1770161705
Registry record updated Jun 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY10000482 Issued in MA
Practice address
55 Fruit St
Boston, MA 02114-2696
Phone
(617) 724-7792
NPI assigned
Mar 31, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSY10000482 MA
Health Psychologist 103TH0004X PSY10000482 MA
Clinical Psychologist 103TC0700X PSY10000482 MA Primary

Addresses

Primary practice location

55 Fruit St
Boston, MA 02114-2696

Mailing address

One Bowdoin Square
9TH Floor
Boston, MA 02114

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240416000954 MA Practitioner - Clinical Psychologist 7012356611 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

50 Staniford St
Boston, MA 02114-2517

55 Fruit St
Boston, MA 02114-2696
Phone (617) 724-0287

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY10000482MAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Massachusetts General Physicians Organization Inc CurrentSince Apr 1, 2024 Accepting new patients
General Hospital Corp Current Accepting new patients
Glynn Consulting & Clinical Services LLC Clinical Current Accepting new patients
The General Hospital Corporation CurrentSince Apr 1, 2024 Accepting new patients
Brigham & Womens Hospital, Inc. CurrentSince Dec 1, 2025 Accepting new patients
Brigham & Womens Physicians Organization Inc CurrentSince Dec 1, 2025 Accepting new patients

Locations

1 Bowdoin Sq
Fl 7
Boston, MA 02114
Phone (617) 643-3997

1 Bowdoin Sq
Fl 9
Boston, MA 02114

75 Francis St
Boston, MA 02115

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

62 13th St
Charlestown, MA 02129
Phone (617) 724-4260

1153 Centre St
Jamaica Plain, MA 02130
Phone (617) 983-7000

399 Revolution Dr
Somerville, MA 02145
Phone (800) 856-1983

Interoperability endpoints

  • Direct secure messaging: glynn.tiffany.mgh@direct.partners.masshiway.net

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750032000000",
    "number": "1770161705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ONE BOWDOIN SQUARE",
            "address_2": "9TH FLOOR",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142696",
            "telephone_number": "617-724-7792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLYNN",
        "first_name": "TIFFANY",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-31",
        "last_updated": "2025-06-16",
        "certification_date": "2025-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MA",
            "license": "PSY10000482",
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "MA",
            "license": "PSY10000482",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "PSY10000482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.