Maryam Rezazadeh, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

11879 Issued in MA

Practice address

200 Baker Ave Ste 203
Concord, MA 01742-2170

Phone

(781) 646-0500

NPI assigned

Mar 18, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Child and Family Psychological Services, PLLC

  • Psychologist
  • Norwood, MA
  • NPI 1912987181

  Clinical

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1426636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662595200000",
    "number": "1982097754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 OAK MEADOW RD",
            "city": "LINCOLN",
            "state": "MA",
            "postal_code": "017732214",
            "telephone_number": "617-758-9786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 BAKER AVE STE 203",
            "city": "CONCORD",
            "state": "MA",
            "postal_code": "017422170",
            "telephone_number": "781-646-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REZAZADEH",
        "first_name": "MARYAM",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-18",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "11879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Sarah Krystyniak Remec, LMHC
• Andrea Resciniti, MD
• Elizabeth L Reuman, PH.D.
• Revival Adult Foster Care
• Brian F. Reynolds, PH.D.
• Lisa Elene Rheaume, RN
• Nancy Richard, MS, PT
• Douglas Richardson, FNP-BC
• Katelyn A Richer, CNM
• Anna Elzbieta Richmon, PSYD

• Clinical Psychologist in Concord, MA
• Providers in Concord, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.