Active NPI
Lissa Marie Dutra, PH.D
- Clinical Psychologist
- Cambridge, MA
National Provider Identifier
1912113564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- TBA
- Practice address
- 2 Brewer St
Cambridge, MA 02138-5710 - Phone
- (617) 230-3002
- NPI assigned
- May 14, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | TBA | MA | Primary |
Addresses
Primary practice location
2 Brewer St
Cambridge, MA 02138-5710
Mailing address
10 Concord Ave
Cambridge, MA 02138-2322
Phone (617) 230-3002
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TBA | MA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475798400000",
"number": "1912113564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 CONCORD AVE",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021382322",
"telephone_number": "617-230-3002",
"fax_number": "617-849-5863"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 BREWER ST",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021385710",
"telephone_number": "617-230-3002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUTRA",
"first_name": "LISSA",
"middle_name": "MARIE",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-14",
"last_updated": "2016-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "TBA",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cambridge, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.