Individual provider Active NPI

Merrill Fowler Mead-Fox, PH.D.

  • Clinical Psychologist
  • Newton Centre, MA
National Provider Identifier
1891849378
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6053 Issued in MA
Practice address
93 Union St
Suite 303a
Newton Centre, MA 02459-2244
Phone
(617) 969-9608
NPI assigned
Jan 22, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 6053 MA Primary

Addresses

Primary practice location

93 Union St
Suite 303a
Newton Centre, MA 02459-2244

Mailing address

93 Union St
Suite 303a
Newton Centre, MA 02459-2244
Phone (617) 969-9608

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
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
6053MAMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891849378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "93 UNION ST",
            "address_2": "SUITE 303A",
            "city": "NEWTON CENTRE",
            "state": "MA",
            "postal_code": "024592244",
            "telephone_number": "617-969-9608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "93 UNION ST",
            "address_2": "SUITE 303A",
            "city": "NEWTON CENTRE",
            "state": "MA",
            "postal_code": "024592244",
            "telephone_number": "617-969-9608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEAD-FOX",
        "first_name": "MERRILL",
        "middle_name": "FOWLER",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "6053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newton Centre, 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.

Verify at the official NPI Registry.