Individual provider Active NPI

Monique Noelle, PHD

  • Clinical Psychologist
  • Cambridge, MA
National Provider Identifier
1770548125
Registry record updated Sep 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
8212 Issued in MA
Practice address
930 Massachusetts Ave
Cambridge, MA 02139-3234
Phone
(617) 388-9985
NPI assigned
Apr 19, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 30, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 8212 MA Primary

Addresses

Primary practice location

930 Massachusetts Ave
Cambridge, MA 02139-3234

Mailing address

930 Massachusetts Ave
Cambridge, MA 02139-3234
Phone (617) 388-9985

Other identifiers 1

IdentifierTypeStateIssuer
W06333OtherBCBS MA

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
I20040927000914 MA Practitioner - Clinical Psychologist 9638148620 Practice locations: Cambridge, MA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

930 Massachusetts Ave
Cambridge, MA 02139-3206

930 Massachusetts Ave
Cambridge, MA 02139-3234
Phone (617) 388-9985

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
8212MAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Jayme Shorin Licsw PastSince Jan 1, 2023 Accepting new patients

Organizations & group practices 1

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": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254268800000",
    "number": "1770548125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 MASSACHUSETTS AVE",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021393234",
            "telephone_number": "617-388-9985",
            "fax_number": "617-844-1606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 MASSACHUSETTS AVE",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021393234",
            "telephone_number": "617-388-9985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOELLE",
        "first_name": "MONIQUE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-19",
        "last_updated": "2009-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "8212",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MA",
            "identifier": "W06333",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cambridge, MA

Sources for this page

Verify at the official NPI Registry.