Active NPI
Karestan Chase Koenen, PH.D.
- Clinical Psychologist
- Cambridge, MA
National Provider Identifier
1962666891
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 8122
- Practice address
- 24 Leonard Ave
Apartment 1
Cambridge, MA 02139-1020 - Phone
- (617) 432-4622
- Fax
- (617) 432-3755
- NPI assigned
- Jul 10, 2008
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 8122 | MA | Primary |
| Clinical Psychologist | 103TC0700X | 014504 | NY |
Addresses
Primary practice location
24 Leonard Ave
Apartment 1
Cambridge, MA 02139-1020
Mailing address
24 Leonard Ave
Apartment 1
Cambridge, MA 02139-1020
Phone (617) 432-4622
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 |
|---|---|---|---|
| 8122 | MA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215648000000",
"number": "1962666891",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24 LEONARD AVE",
"address_2": "APARTMENT 1",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021391020",
"telephone_number": "617-432-4622",
"fax_number": "617-432-3755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24 LEONARD AVE",
"address_2": "APARTMENT 1",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021391020",
"telephone_number": "617-432-4622",
"fax_number": "617-432-3755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOENEN",
"first_name": "KARESTAN",
"middle_name": "CHASE",
"name_prefix": "Ms.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-07-10",
"last_updated": "2008-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "8122",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "014504",
"primary": false
}
],
"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 Jul 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.