Walpole Behavioral Healthcare

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

4743 Issued in MA

Legal business name

WALPOLE BEHAVIORAL HEALTHCARE

Practice address

841 Main St LL2
Walpole, MA 02081-2997

Phone

(508) 668-6053

Fax

(508) 422-7297

NPI assigned

Oct 6, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Frederick Paul HoranNPI 1558345611

Title

Director

Phone

(508) 668-6053

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Frederick Paul Horan, PH.D.

  • Psychologist
  • Walpole, MA
  • NPI 1558345611
  Medicare reassignment NPD Authorized official
• Lisa Rukhsana Ahmed, MSW, LICSW

  • Clinical Social Worker
  • Walpole, MA
  • NPI 1295710549
  Medicare reassignment NPD
• Lindsay Blake Amper, MED

  • Student in an Organized Health Care Education/Training Program
  • Roslindale, MA
  • NPI 1336336262
  NPD (past)
• Kerry Lynn Desista, LCSW

  • Clinical Social Worker
  • Medford, MA
  • NPI 1063599579
  NPD (past)
• Katherine Emilie Herzog, PSY.D.

  • Psychologist
  • Walpole, MA
  • NPI 1457548299
  NPD (past)

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

{
    "created_epoch": "1317859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641427200000",
    "number": "1881978971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 COMMON ST UNIT 64",
            "city": "WALPOLE",
            "state": "MA",
            "postal_code": "020819203",
            "telephone_number": "508-668-6053",
            "fax_number": "508-422-7297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 MAIN ST LL2",
            "city": "WALPOLE",
            "state": "MA",
            "postal_code": "020812997",
            "telephone_number": "508-668-6053",
            "fax_number": "508-422-7297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALPOLE BEHAVIORAL HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-06",
        "last_updated": "2022-01-06",
        "certification_date": "2021-12-05",
        "status": "A",
        "authorized_official_last_name": "HORAN",
        "authorized_official_first_name": "FREDERICK",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "508-668-6053",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "4743",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Kelley Wallace, LICSW
• Walpole Area Visiting Nurse Association, Inc
• Walpole Area Visiting Nurse Association, Inc.
• Walpole Behavioral Healthcare, LLC
• Walpole Chiropractic Office, Inc.
• Walpole Medical Associates, PC
• Walpole Medical Center, PC
• Walpole Pediatric Assoc., PC

• Clinical Psychologist in Walpole, MA
• Providers in Walpole, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.