Active NPI
Evan Moran Queenan
- Clinical Psychologist
- Brighton, MA
National Provider Identifier
1790294981
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY10000877
- Practice address
- 77 Warren St
Brighton, MA 02135 - Phone
- (617) 254-1271
- NPI assigned
- Sep 20, 2017
- Last updated
- Oct 8, 2026
- 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 | PSY10000877 | MA | Primary |
Addresses
Primary practice location
77 Warren St
Brighton, MA 02135
Mailing address
77 Warren St
Brighton, MA 02135-3601
Other practice location 1
3 Boulevard St Ste 1R
Milton, MA 02186-5400
Phone (508) 682-9570
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505865600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1791417600000",
"number": "1790294981",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "77 WARREN ST",
"city": "BRIGHTON",
"state": "MA",
"postal_code": "021353601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "77 WARREN ST",
"city": "BRIGHTON",
"state": "MA",
"postal_code": "02135",
"telephone_number": "617-254-1271"
}
],
"practiceLocations": [
{
"address_1": "3 Boulevard St Ste 1R",
"address_purpose": "LOCATION",
"city": "Milton",
"state": "MA",
"postal_code": "021865400",
"country_code": "US",
"telephone_number": "508-682-9570",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "QUEENAN",
"first_name": "EVAN",
"middle_name": "MORAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-09-20",
"last_updated": "2026-10-08",
"certification_date": "2026-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "PSY10000877",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brighton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.