Active NPI
Mitchell Robert Bornstein, PHD.
- Clinical Psychologist
- Wellesley, MA
National Provider Identifier
1962648477
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2514
- Practice address
- 260 Wellesley Ave
Wellesley, MA 02481-6809 - Phone
- (781) 235-6721
- NPI assigned
- Jan 5, 2009
- Sex
- Male
- 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 | 2514 | MA | Primary |
Addresses
Primary practice location
260 Wellesley Ave
Wellesley, MA 02481-6809
Mailing address
260 Wellesley Ave
Wellesley, MA 02481-6809
Phone (781) 235-6721
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
| License | State | Type | Specialty |
|---|---|---|---|
| 2514 | MA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231113600000",
"number": "1962648477",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "260 WELLESLEY AVE",
"city": "WELLESLEY",
"state": "MA",
"postal_code": "024816809",
"telephone_number": "781-235-6721"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "260 WELLESLEY AVE",
"city": "WELLESLEY",
"state": "MA",
"postal_code": "024816809",
"telephone_number": "781-235-6721"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORNSTEIN",
"first_name": "MITCHELL",
"middle_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "PHD.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-01-05",
"last_updated": "2009-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "2514",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wellesley, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 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.