DR. JACQUELINE ANNE SAMSON (NPI# 1467454652) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467454652 |
| Entity Type | Individual |
| Full Name | DR. JACQUELINE ANNE SAMSON |
| Other Name | MS. JACQUELINE ANNE SAMSON-JAIN |
| Credential | PH.D. |
| Practice Address |
115 Mill St Belmont MA 02478-1041 |
| Practice Telephone | 6178553348 |
| Practice Fax Number | 6178552936 |
| Mailing Telephone | 6178553348 |
| Mailing Fax Number | 6178552936 |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2010-07-09 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103T00000X | Psychologist | 4522 | MA | Behavioral Health & Social Service Providers |
| Y | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
4522 | MA | Behavioral Health & Social Service Providers |
| N | 103TC0700X |
Psychologist Specialization: Clinical |
4522 | MA | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | MASSHEALTH | 1858807 | 01 |
| MA | BLUE CROSS BLUE SHIELD | W05381 | 01 |
| MA | VALUE OPTIONS | 01950 | 01 |
| MA | HARVARD PILGRIM HEALTH CA | 001458 | 01 |
| Street Address |
115 MILL ST |
| City | BELMONT |
| State | MA |
| Zip Code | 02478-1041 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326647520 | Jacqueline Bullis | Psychologist | 115 Mill St, Belmont, MA 02478-1048 | 2020-10-20 |
| 1578162707 | Caleb Zachary Demers | Social Worker | 115 Mill St, Belmont, MA 02478-1048 | 2020-10-19 |
| 1083221428 | Noa Kupfer | Social Worker | 115 Mill St, Belmont, MA 02478-1064 | 2020-09-29 |
| 1154936490 | Remy Sky Leutwyler | Social Worker | 115 Mill St, Belmont, MA 02478-1064 | 2020-09-14 |
| 1699380295 | Denice Cronin | Psychologist | 115 Mill St, Belmont, MA 02478-1064 | 2020-09-10 |
| 1033724851 | Amanda Sedgewick, Pllc | Clinic/Center | 115 Mill St, Belmont, MA 02478-1064 | 2020-09-09 |
| 1013529015 | Miqveh Steinhart | Social Worker | 115 Mill St, Belmont, MA 02478-1064 | 2020-08-20 |
| 1801407820 | Lindsay Amateis | Social Worker | 115 Mill St, Belmont, MA 02478-1064 | 2020-08-13 |
| 1790395671 | Patrick Shanley | Social Worker | 115 Mill St, Mclean Hospital Mail Stop 106, Belmont, MA 02478 | 2020-08-05 |
| 1528678968 | Sarah Bekele | Registered Nurse | 115 Mill St, Belmont, MA 02478-1064 | 2020-07-31 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760089924 | Emily Boyko | Physical Therapist | 413 Trapelo Rd, 2, Belmont, MA 02478 | 2020-10-01 |
| 1326695636 | Kristen Perrelli | Social Worker | 115 Mill Street Mail Stop 207, Belmont, MA 02478 | 2019-08-21 |
| 1265905210 | Deborah J Fenn | Social Worker | 88 Palfrey Rd, Belmont, MA 02478 | 2019-01-02 |
| 1922578855 | The Psych Garden LLC | Counselor | 25 Flanders Road, Belmont, MA 02478 | 2018-12-04 |
| 1083199855 | Wendi Goldberg | Social Worker | 1 15 Mill Street, Belmont, MA 02478 | 2018-09-27 |
| 1124514146 | Ann Polcari | Clinical Nurse Specialist | Service Building Mc Lean Hospital, 115 Mill Street, Belmont, MA 02478 | 2018-07-02 |
| 1245722701 | Jeremy Stewart | Psychologist | Mclean Hospital, 115 Mill Street, Mailstop 331, Belmont, MA 02478 | 2018-05-31 |
| 1295257848 | Stephanie Boyer | Psychologist | Mclean Hospital, 115 Mill St., Mail Stop 131, Belmont, MA 02478 | 2017-07-14 |
| 1497281893 | The Meraki Center for Therapeutic Arts | Community/Behavioral Health | 431 Trapelo Rd, Belmont, MA 02478 | 2017-05-04 |
| 1275908063 | Alex Jordan | Psychologist | 115 Mill Street, Mail Stop 217, Mclean Hospital, Belmont, MA 02478 | 2015-12-05 |
| Find all providers in zip 02478 | ||||
| Taxonomy Code | 103TB0200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Cognitive & Behavioral |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326536251 | Christian Anthony Webb | Psychologist | 115 Mill Street, Demarneffe Building Room 240, Belmont, MA 02478 | 2018-04-26 |
| 1033534771 | Matthew Schrock | Psychologist | 115 Mill St, Recreation Building, Belmont, MA 02478-1064 | 2014-03-04 |
| 1235551912 | Lawrence Ian Reed | Psychologist | 115 Mill St, Belmont, MA 02478-1064 | 2014-01-14 |
| 1407121197 | Fairlee Cecilia Fabrett | Psychologist | 115 Mill St, Belmont, MA 02478-1064 | 2012-03-14 |
| 1588978316 | Courtney Beard Elias | Psychologist | 115 Mill St, Belmont, MA 02478 | 2010-08-04 |
| 1255588034 | Isabelle M Rosso | Psychologist | 115 Mill St, Belmont, MA 02478-1064 | 2008-08-22 |
| 1891883831 | Jenifer M Cullen | Psychologist | 115 Mill St, Belmont, MA 02478-1064 | 2006-10-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740807528 | Centi Psychological Services Pllc | Psychologist | 35 Renwick Rd, Melrose, MA 02176-1218 | 2020-06-29 |
| 1760008072 | Louise Ross | Psychologist | 223 Bishops Forest Dr, Waltham, MA 02452-8804 | 2020-06-23 |
| 1417419060 | John Benjamin Barnes | Psychologist | 76 Davidson Rd, Framingham, MA 01701-3292 | 2019-04-03 |
| 1508351107 | Breanna Wardwell | Psychologist | 110 Maple St Ste 110, Springfield, MA 01105 | 2018-06-26 |
| 1376038372 | Ellen Leigh | Psychologist | 8 Summer St Apt 105, Arlington, MA 02474-3059 | 2018-06-22 |
| 1538650601 | Leonard Anthony Doerfler | Psychologist | 26 Pinedale Rd, Shrewsbury, MA 01545-3502 | 2018-05-24 |
| 1700389749 | Arden Sugeily Lake | Psychologist | 50 Annafran St, Roslindale, MA 02131-4705 | 2018-03-15 |
| 1780183277 | Laurence James Stybel | Psychologist | 27 Bayfield Rd, Wayland, MA 01778-4205 | 2018-02-09 |
| 1114449931 | Stephanie M Ribeiro | Psychologist | 27 Stratfield Ave, Westfield, MA 01085-2222 | 2017-07-13 |
| 1033650908 | Jean Curtis Loud | Psychologist | 17 East Chop Drive, Oak Bluffs, MA 02557 | 2017-03-13 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.