Active NPI
Jane Hanenberg, ED.D.
- Psychologist
- Watertown, MA
National Provider Identifier
1881749950
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 3239
- Practice address
- 173 Mt. Auburn St.
Watertown, MA 02472-4005 - Phone
- (617) 924-3119
- Fax
- (617) 924-3119
- NPI assigned
- Jan 25, 2007
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 3239 | MA | Primary |
Addresses
Primary practice location
173 Mt. Auburn St.
Watertown, MA 02472-4005
Mailing address
173 Mt. Auburn St.
Watertown, MA 02472-4005
Phone (617) 924-3119
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 22, 2025 through Jan 22, 2027
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": "1169683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881749950",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "173 MT. AUBURN ST.",
"city": "WATERTOWN",
"state": "MA",
"postal_code": "024724005",
"telephone_number": "617-924-3119",
"fax_number": "617-924-3119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "173 MT. AUBURN ST.",
"city": "WATERTOWN",
"state": "MA",
"postal_code": "024724005",
"telephone_number": "617-924-3119",
"fax_number": "617-924-3119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANENBERG",
"first_name": "JANE",
"credential": "ED.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "3239",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Watertown, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.