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300 Longwood Ave Boston MA 02115-5724 | |
| (617) 355-4831 | |
| (617) 730-0080 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 300 Longwood Ave, Boston, Massachusetts |
| Authorized Official Name and Position | Steven D Nicoll (DIRECTOR PATIENT FINANCIAL SERVICE) |
| Authorized Official Contact | 8572183391 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
300 Longwood Ave Boston MA 02115-5724 Ph: (617) 355-4831 | 300 Longwood Ave Boston MA 02115-5724 Ph: (617) 355-4831 |
| NPI Number | 1629148036 |
|---|---|
| Provider Enumeration Date | 11/09/2006 |
| Last Update Date | 03/13/2023 |
| Certification Date | 03/13/2023 |
| Medicare PECOS PAC ID | 3274758883 |
|---|---|
| Medicare Enrollment ID | O20140715000668 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629148036 | NPI | - | NPPES |
| 103TP2701X | Other | MA | PSYCHIATRY |
| Provider Name | Michael W Tsappis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184713380 PECOS PAC ID: 2466481650 Enrollment ID: I20050808001060 |
| Provider Name | David R Demaso |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831163658 PECOS PAC ID: 8123058047 Enrollment ID: I20050819000278 |
| Provider Name | Matthew S Siegel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134347560 PECOS PAC ID: 4284707779 Enrollment ID: I20080924000163 |
| Provider Name | Nina R Graupera |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538326814 PECOS PAC ID: 9931247285 Enrollment ID: I20091106000538 |
| Provider Name | Tatjana Dujmic |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336289099 PECOS PAC ID: 2365571726 Enrollment ID: I20100522000105 |
| Provider Name | Kaizad Munshi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619003290 PECOS PAC ID: 8820121429 Enrollment ID: I20100803000912 |
| Provider Name | Chase B Samsel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033370606 PECOS PAC ID: 4284891797 Enrollment ID: I20120210000033 |
| Provider Name | Loren J D'angelo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417103193 PECOS PAC ID: 4486816568 Enrollment ID: I20120507000715 |
| Provider Name | Olivia K Carrick |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457513061 PECOS PAC ID: 6608027750 Enrollment ID: I20121119000338 |
| Provider Name | Monique V Ribeiro |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821273723 PECOS PAC ID: 7618104787 Enrollment ID: I20131217000281 |
| Provider Name | Joseph M Gonzalez Heydrich |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598833378 PECOS PAC ID: 9537389960 Enrollment ID: I20141006001838 |
| Provider Name | Hesham M Hamoda |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548449796 PECOS PAC ID: 3971724782 Enrollment ID: I20141021000243 |
| Provider Name | I Simona Bujoreanu |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699922534 PECOS PAC ID: 7810118460 Enrollment ID: I20141023000349 |
| Provider Name | Patricia I Ibeziako |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851500300 PECOS PAC ID: 6002037462 Enrollment ID: I20141028001810 |
| Provider Name | Serena Ann Fernandes |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851534788 PECOS PAC ID: 5991943037 Enrollment ID: I20150728004304 |
| Provider Name | Kevin K Tsang |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295044683 PECOS PAC ID: 3375725427 Enrollment ID: I20151103003125 |
| Provider Name | Deepika Shaligram |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275709263 PECOS PAC ID: 8123338480 Enrollment ID: I20151117001536 |
| Provider Name | Oscar G Bukstein |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831161876 PECOS PAC ID: 5890864912 Enrollment ID: I20160504002299 |
| Provider Name | John Prescott Glazer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528026101 PECOS PAC ID: 4981592839 Enrollment ID: I20161026000486 |
| Provider Name | Tamar C Katz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235577230 PECOS PAC ID: 4880822980 Enrollment ID: I20170403000207 |
| Provider Name | Meredith Gansner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659613008 PECOS PAC ID: 3971871252 Enrollment ID: I20170608002000 |
| Provider Name | Linsey S Gill |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477997021 PECOS PAC ID: 4981990603 Enrollment ID: I20180716001144 |
| Provider Name | Yohanis L. Anglero Diaz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881037695 PECOS PAC ID: 2961627815 Enrollment ID: I20180815003150 |
| Provider Name | Zheala Qayyum |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790910925 PECOS PAC ID: 7719039296 Enrollment ID: I20181009003098 |
| Provider Name | Brittany Catherine Hines |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730661042 PECOS PAC ID: 3476806746 Enrollment ID: I20181102001863 |
| Provider Name | Susan M Cullaty-purvis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184199747 PECOS PAC ID: 5496009185 Enrollment ID: I20181115001815 |
| Provider Name | Kevin M Simon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386031631 PECOS PAC ID: 9739484320 Enrollment ID: I20190228001307 |
| Provider Name | Sonia M Joy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114244027 PECOS PAC ID: 7315247954 Enrollment ID: I20190514001239 |
| Provider Name | Annmarie Caracansi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053633511 PECOS PAC ID: 9739413410 Enrollment ID: I20190701000133 |
| Provider Name | Ethan T Anglemyer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1770996068 PECOS PAC ID: 7416280128 Enrollment ID: I20190724000861 |
| Provider Name | Hoa Lam Schneider |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1528615721 PECOS PAC ID: 2860824497 Enrollment ID: I20191119002723 |
| Provider Name | Heather E Potts |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1366098741 PECOS PAC ID: 9032542998 Enrollment ID: I20191206000631 |
| Provider Name | Ireen Ahmed |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548674807 PECOS PAC ID: 5698064830 Enrollment ID: I20200102002435 |
| Provider Name | Shuang Li |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326433863 PECOS PAC ID: 0547510612 Enrollment ID: I20200107000191 |
| Provider Name | Jung Kim |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316201080 PECOS PAC ID: 1557639010 Enrollment ID: I20200811002256 |
| Provider Name | Lauren Michelle Mednick |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1194894576 PECOS PAC ID: 9638597800 Enrollment ID: I20200921001412 |
| Provider Name | Imari-ashley Fulache Palma |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1780202846 PECOS PAC ID: 8022428424 Enrollment ID: I20201112002529 |
| Provider Name | Ryan P Oconnor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174899595 PECOS PAC ID: 4385968460 Enrollment ID: I20210114002244 |
| Provider Name | Rachel A Landsman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912427071 PECOS PAC ID: 2062826571 Enrollment ID: I20210125001361 |
| Provider Name | Rose Ashraf |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1629676960 PECOS PAC ID: 4284049487 Enrollment ID: I20210222001574 |
| Provider Name | Yasmin C Cole-lewis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881036994 PECOS PAC ID: 5597171637 Enrollment ID: I20210315002366 |
| Provider Name | Billy J Zou |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538517172 PECOS PAC ID: 5890081749 Enrollment ID: I20210428001366 |
| Provider Name | Charles R Wulff |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538516489 PECOS PAC ID: 7113206889 Enrollment ID: I20210615002171 |
| Provider Name | Raina M Milne |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316394653 PECOS PAC ID: 0941595383 Enrollment ID: I20211026002771 |
| Provider Name | Vivek Jain |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831380856 PECOS PAC ID: 5092052126 Enrollment ID: I20211124001615 |
| Provider Name | Peter Bachman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1275150021 PECOS PAC ID: 0042605818 Enrollment ID: I20220314000359 |
| Provider Name | Alice S Lowy |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649838467 PECOS PAC ID: 2062809148 Enrollment ID: I20220419001672 |
| Provider Name | Beth Ann Logan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1164831632 PECOS PAC ID: 9436371937 Enrollment ID: I20220421002602 |
| Provider Name | Erin Cooper Dunn |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548799117 PECOS PAC ID: 6709159627 Enrollment ID: I20220711001810 |
| Provider Name | Sherry Paden |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609486638 PECOS PAC ID: 2163804758 Enrollment ID: I20220728002517 |
| Provider Name | Stephanie A Lichtor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356634505 PECOS PAC ID: 0042439580 Enrollment ID: I20220808003218 |
| Provider Name | Loretta M Iwanoski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871168914 PECOS PAC ID: 2668857483 Enrollment ID: I20220915000313 |
| Provider Name | Rahma Hida |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1336891571 PECOS PAC ID: 0042696312 Enrollment ID: I20221011000367 |
| Provider Name | Sara Medina-devilliers |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1174267066 PECOS PAC ID: 1254700537 Enrollment ID: I20221208000401 |
| Provider Name | Marguerite R Schneider |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740635796 PECOS PAC ID: 6800261090 Enrollment ID: I20230330001965 |
| Provider Name | Omar A. Shah |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285043778 PECOS PAC ID: 6103242011 Enrollment ID: I20230508001804 |
| Provider Name | Aakash Sathappan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366903882 PECOS PAC ID: 7810354206 Enrollment ID: I20230530001919 |
| Provider Name | Stacy S Drury |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316945116 PECOS PAC ID: 9739261025 Enrollment ID: I20230626001682 |
| Provider Name | Katherine A Epstein |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992209969 PECOS PAC ID: 2769845114 Enrollment ID: I20230831004257 |
| Provider Name | Madeleine Flora Wittenberg |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1841078037 PECOS PAC ID: 8325481278 Enrollment ID: I20240207002012 |
| Provider Name | Gino A Mortillaro |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811321920 PECOS PAC ID: 1456602150 Enrollment ID: I20240222003633 |
| Provider Name | Maria Del Pilar Trelles Thorne |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558505891 PECOS PAC ID: 8426329038 Enrollment ID: I20240410002900 |
| Provider Name | Linda Y Gao |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538690847 PECOS PAC ID: 5890031546 Enrollment ID: I20240424000940 |
| Provider Name | Gretchen M Cruz Figueroa |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1225406069 PECOS PAC ID: 1355677790 Enrollment ID: I20240515000922 |
| Provider Name | Ana Maria Munkenbeck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629850235 PECOS PAC ID: 7618410044 Enrollment ID: I20240613003209 |
| Provider Name | Hallie Gorica |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346819505 PECOS PAC ID: 7214329580 Enrollment ID: I20240614000364 |
| Provider Name | Ashley V Adams |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790342053 PECOS PAC ID: 7911230073 Enrollment ID: I20240625000464 |
| Provider Name | Samantha Awada |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1316529860 PECOS PAC ID: 3870038904 Enrollment ID: I20240713000089 |
| Provider Name | Sonal Jain |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144781402 PECOS PAC ID: 9739415316 Enrollment ID: I20240827001206 |
| Provider Name | Sion Kim Harris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205616984 PECOS PAC ID: 9830630664 Enrollment ID: I20240920000910 |
| Provider Name | Amber A Graham |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1396325254 PECOS PAC ID: 1951832336 Enrollment ID: I20241009003254 |
| Provider Name | Mary Margaret Gleason |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023136389 PECOS PAC ID: 9032219969 Enrollment ID: I20241025003033 |
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