Active NPI
Lydia Kenin, PSYD, LICSW
- Psychologist
- Waban, MA
National Provider Identifier
1902042344
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 4186
- Practice address
- 45 Metacomet Rd
Waban, MA 02468-1418 - Phone
- (617) 969-7393
- NPI assigned
- Jan 6, 2009
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 4186 | MA | Primary |
| Clinical Social Worker | 1041C0700X | 103930 | MA |
Addresses
Primary practice location
45 Metacomet Rd
Waban, MA 02468-1418
Mailing address
45 Metacomet Rd
Waban, MA 02468-1418
Phone (617) 969-7393
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| W50166 | Other | MA | MEDICARE PARTICIPATING SUPPLIER IDENTIFICATION CODE |
| WO5557 | Other | MA | BLUE CROSS BLUE SHIELD |
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 |
|---|---|---|---|
| 103930 | MA | MD | Clinical Social Worker |
| 4186 | MA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231200000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231200000000",
"number": "1902042344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45 METACOMET RD",
"city": "WABAN",
"state": "MA",
"postal_code": "024681418",
"telephone_number": "617-969-7393"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "45 METACOMET RD",
"city": "WABAN",
"state": "MA",
"postal_code": "024681418",
"telephone_number": "617-969-7393"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENIN",
"first_name": "LYDIA",
"name_prefix": "Dr.",
"credential": "PSYD, LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-01-06",
"last_updated": "2009-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "4186",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "103930",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PARTICIPATING SUPPLIER IDENTIFICATION CODE",
"identifier": "W50166",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "WO5557",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waban, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.