Active NPI
Jaclyn Gildea Mark, C.R.C.
- Rehabilitation Psychologist
- Chelsea, MA
National Provider Identifier
1881806065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Psychologist
- License
- 00098922
- Practice address
- 301 Broadway
Chelsea, MA 02150 - Phone
- (617) 488-5706
- NPI assigned
- May 3, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Rehabilitation Psychologist | 103TR0400X | 00098922 | MA | Primary |
Addresses
Primary practice location
301 Broadway
Chelsea, MA 02150
Mailing address
1381 Commonwealth Ave.
Allston, MA 02151
Phone (617) 488-5706
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00098922 | MA | MD | Rehabilitation Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881806065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1381 COMMONWEALTH AVE.",
"city": "ALLSTON",
"state": "MA",
"postal_code": "02151",
"telephone_number": "617-488-5706"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 BROADWAY",
"city": "CHELSEA",
"state": "MA",
"postal_code": "02150",
"telephone_number": "617-488-5706"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARK",
"first_name": "JACLYN",
"middle_name": "GILDEA",
"credential": "C.R.C.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TR0400X",
"taxonomy_group": "",
"desc": "Psychologist, Rehabilitation",
"state": "MA",
"license": "00098922",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chelsea, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.