Active NPI
Alicia Gapen, LEP
- Psychologist
- Agawam, MA
National Provider Identifier
1902667637
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LEP10000001
- Practice address
- 2 S Bridge Dr Ste 1B
Agawam, MA 01001-2000 - Phone
- (603) 903-7311
- NPI assigned
- Jan 19, 2024
- Last updated
- Jan 19, 2024
- 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 | LEP10000001 | MA | Primary |
| School Psychologist | 103TS0200X | 439399 | MA |
Addresses
Primary practice location
2 S Bridge Dr Ste 1B
Agawam, MA 01001-2000
Mailing address
74 Perkins St
Springfield, MA 01118-2044
Phone (603) 903-7311
Other names 1
- Alicia Boudreault
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 |
|---|---|---|---|
| LEP10000001 | MA | MD | Psychologist |
| 439399 | MA | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1705622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705622400000",
"number": "1902667637",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "74 PERKINS ST",
"city": "SPRINGFIELD",
"state": "MA",
"postal_code": "011182044",
"telephone_number": "603-903-7311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 S BRIDGE DR STE 1B",
"city": "AGAWAM",
"state": "MA",
"postal_code": "010012000",
"telephone_number": "603-903-7311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAPEN",
"first_name": "ALICIA",
"credential": "LEP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-01-19",
"last_updated": "2024-01-19",
"certification_date": "2024-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "LEP10000001",
"primary": true
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "MA",
"license": "439399",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "ALICIA",
"last_name": "BOUDREAULT",
"code": "1",
"type": "Former Name"
}
]
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.