NPI |
1093851800 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
PATHWAYS PSYCHOLOGICAL SERVICES, LLC |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider First Line Business Practice Location Address |
77 WARREN ST |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Second Line Business Practice Location Address |
EAST HALL |
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot
include a Post Office box. |
Provider Business Practice Location Address City Name |
BRIGHTON |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
MA |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
021353601 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
6172544018 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
1/29/2007 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
8/22/2020 |
The date that a record was last updated or changed. |
Authorized Official Last Name |
SAFFO |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official First Name |
CRISTIN |
The telephone number associated with the location address of the provider being identified. |
Authorized Official Middle Name |
M. |
The middle name of the authorized official. |
Authorized Official Title or Position |
MEMBER |
The title or position of the authorized official. |
Authorized Official Telephone Number |
6172544018 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
103T00000X |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Provider License Number 1 |
7380 |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Provider License Number State Code 1 |
MA |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Is Organization Subpart |
N |
|
Authorized Official Credential Text |
PSY.D. |
|
Healthcare Provider Taxonomy Group 1 |
193400000X SINGLE SPECIALTY GROUP |
|