Individual provider Active NPI

Monika Ewa Kolodziej, PH.D.

  • Clinical Psychologist
  • Worcester, MA
National Provider Identifier
1811024623
Registry record updated Oct 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
7764 Issued in MA
Practice address
469 Chandler St
Worcester, MA 01602-2529
Phone
(508) 410-9535
NPI assigned
Feb 28, 2007
Last updated
Oct 20, 2009By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 20, 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 7764 MA Primary

Addresses

Primary practice location

469 Chandler St
Worcester, MA 01602-2529

Mailing address

469 Chandler Street
Worcester, MA 01602-2529
Phone (508) 410-9535

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
I20100204000466 MA Practitioner - Clinical Psychologist 8921141524 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Reliant Medical Group IncGroup PAC ID 5597755322, 638 clinicians

Practice addresses (Care Compare)

5 Neponset St
Worcesteer, MA 01606-2714
Phone (508) 595-2300

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7764MAMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The McLean Hospital Corporation Clinical CurrentSince Oct 1, 2019 Accepting new patients

Locations

115 Mill St
Belmont, MA 02478
Phone (617) 855-2000

23 Isaac St
Middleboro, MA 02346
Phone (774) 419-1000

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1255996800000",
    "number": "1811024623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "469 CHANDLER STREET",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016022529",
            "telephone_number": "508-410-9535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "469 CHANDLER ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016022529",
            "telephone_number": "508-410-9535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLODZIEJ",
        "first_name": "MONIKA",
        "middle_name": "EWA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-28",
        "last_updated": "2009-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "7764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.