Active NPI
Jill Larsen, BCBA
- Intellectual & Developmental Disabilities Psychologist
- Beverly, MA
National Provider Identifier
1972700433
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Intellectual & Developmental Disabilities Psychologist
- License
- 1073293
- Practice address
- 100 Cummings Center
Suite 151-B
Beverly, MA 01915 - Phone
- (978) 993-8096
- NPI assigned
- Jun 28, 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 |
|---|---|---|---|---|
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | 1073293 | MA | Primary |
Addresses
Primary practice location
100 Cummings Center
Suite 151-B
Beverly, MA 01915
Mailing address
100 Cummings Center
Suite 151-B
Beverly, MA 01915
Phone (978) 993-8096
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 |
|---|---|---|---|
| 1073293 | MA | MD | Intellectual & Developmental Disabilities Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182988800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1972700433",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 CUMMINGS CENTER",
"address_2": "SUITE 151-B",
"city": "BEVERLY",
"state": "MA",
"postal_code": "01915",
"telephone_number": "978-993-8096"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 CUMMINGS CENTER",
"address_2": "SUITE 151-B",
"city": "BEVERLY",
"state": "MA",
"postal_code": "01915",
"telephone_number": "978-993-8096"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSEN",
"first_name": "JILL",
"credential": "BCBA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TM1800X",
"taxonomy_group": "",
"desc": "Psychologist, Intellectual & Developmental Disabilities",
"state": "MA",
"license": "1073293",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beverly, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.