Active NPI
Kelly Michelle Wawrzyniak, PSYD
- Clinical Psychologist
- Waltham, MA
National Provider Identifier
1780020990
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 9672
- Practice address
- 85 1St Ave
Waltham, MA 02451-1105 - Phone
- (781) 647-7246
- NPI assigned
- May 14, 2013
- 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 Psychologist | 103TC0700X | 9672 | MA | Primary |
Addresses
Primary practice location
85 1St Ave
Waltham, MA 02451-1105
Mailing address
14 Smythe St
Apt 2
Brookline, MA 02445-7662
Phone (585) 820-4048
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Aug 1, 2023 through Aug 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1368489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1368489600000",
"number": "1780020990",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14 SMYTHE ST",
"address_2": "APT 2",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024457662",
"telephone_number": "585-820-4048"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "85 1ST AVE",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024511105",
"telephone_number": "781-647-7246"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAWRZYNIAK",
"first_name": "KELLY",
"middle_name": "MICHELLE",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-05-14",
"last_updated": "2013-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "9672",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waltham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.