CHILD DEVELOPMENT NETWORK (NPI# 1902952658) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902952658 |
| Entity Type | Organization |
| Organization Name | CHILD DEVELOPMENT NETWORK |
| Practice Address |
76 Bedford St Ste 12 Lexington MA 02420-4640 |
| Practice Telephone | 7818616655 |
| Practice Fax Number | 7818616654 |
| Mailing Telephone | 7818616655 |
| Mailing Fax Number | 7818616654 |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. JANINE KORAHAIS STASIOR (NEUROPSYCHOLOGIST, BUSINESS OWNER) |
| Authorized Official Telephone | 7818616655 |
| Authorized Official Credential | PHD, MS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | BLUE CROSS BLUE SHIELD | W10652 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609110378 | Child Development Network | Physical Therapist | 123 W Padre St Ste F, Santa Barbara, CA 93105-3960 | 2012-11-19 |
| Street Address |
76 BEDFORD ST STE 12 |
| City | LEXINGTON |
| State | MA |
| Zip Code | 02420-4640 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851317291 | Janine Korahais Stasior | Clinical Neuropsychologist | 76 Bedford St Ste 12, Lexington, MA 02420-4640 | 2006-07-15 |
| 1740765254 | Nancy Page Kohlhepp | Social Worker | 76 Bedford St Ste 12, Lexington, MA 02420-4640 | 2018-10-01 |
| 1568912525 | Sarah Backe | Clinical Neuropsychologist | 76 Bedford St Ste 12, Lexington, MA 02420-4640 | 2016-10-13 |
| 1275901522 | Marlene Major | Psychologist | 76 Bedford St Ste 12, Lexington, MA 02420-4640 | 2015-09-03 |
| 1629208202 | Jessica Wexler | Psychologist | 76 Bedford St Ste 12, Lexington, MA 02420-4640 | 2009-07-17 |
| 1750537403 | Stephanie M Power | Psychologist | 76 Bedford St Ste 12, Lexington, MA 02420-4640 | 2008-08-13 |
| 1023202389 | Child Development Network, LLC | Speech-Language Pathologist | 76 Bedford St Ste 12, Lexington, MA 02420-4640 | 2007-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568958643 | Kristen Gargiulo | Physical Therapist | 57 Bedord Street, Ste 202, Lexington, MA 02420 | 2018-07-02 |
| 1902311616 | Lindsey Nicole Wilcox | Physical Therapist | 57 Bedford St Ste 202, Lexington, MA 02420 | 2017-12-05 |
| 1629590443 | Jeffrey Phillip Winer | Psychologist | 57 Bedford St Ste 230, Lexington, MA 02420 | 2017-07-13 |
| 1235678178 | Rebecca Munini | Counselor | 76 Bedford Street, Suite 12, Office 1, Lexington, MA 02420 | 2017-02-13 |
| 1700332376 | Aretha Cohen | Speech-Language Pathologist | 840 Emerson Gardens Road, Excel Center, Lexington, MA 02420 | 2016-09-01 |
| 1710387915 | Niravkumar Patel | Internal Medicine | 4 Hadley Rd, Lexington, MA 02420 | 2014-08-26 |
| 1316368749 | Triad Adolescent Services | Counselor | 363 Mass Ave, Suite 204, Lexington, MA 02420 | 2014-01-03 |
| 1447698063 | Emily Flier Matteodo | Psychiatry & Neurology | 35 Bedford Street, Suite #6, Lexington, MA 02420 | 2013-06-05 |
| 1780941914 | Varun Kapur | Surgery | 33 York St, Lexington, MA 02420 | 2012-04-12 |
| 1992091433 | Karolyn Mary Franz | Acupuncturist | 238 Bedford St Ste 5, Lexington, MA 02420 | 2011-06-23 |
| Find all providers in zip 02420 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558686725 | Daniel Kendig Reinstein Iv | Clinical Neuropsychologist | 187 Spring St, Lexington, MA 02421-8030 | 2010-03-31 |
| 1275735557 | Harvey Irwin Botman | Clinical Neuropsychologist | Suite 3, 15 Depot Square, Lexington, MA 02420-6330 | 2007-05-31 |
| 1043360936 | Hugh Coffman | Clinical Neuropsychologist | 76 Bedford St Ste 17, Lexington, MA 02420-4640 | 2007-01-11 |
| 1346399318 | Peter Judson Gager | Clinical Neuropsychologist | 3175 Custer Dr Ste 302b, Lexington, KY 40517-4023 | 2007-01-09 |
| 1861565210 | Lacey K Price | Clinical Neuropsychologist | 711 Millpond Rd, Lexington, KY 40514-1561 | 2006-11-15 |
| 1144306515 | David T Berry | Clinical Neuropsychologist | Psychology 125 Kastle Hall, University of Kentucky, Lexington, KY 40506-0001 | 2006-10-28 |
| 1851317291 | Janine Korahais Stasior | Clinical Neuropsychologist | 76 Bedford St Ste 12, Lexington, MA 02420-4640 | 2006-07-15 |
| 1477535250 | Timothy J Carbary | Clinical Neuropsychologist | 261 Regency Cir, Suite 4, Lexington, KY 40503-2348 | 2005-11-16 |
| 1285168260 | Lisa Koehl | Clinical Neuropsychologist | 740 S Limestone, Ky Clinic, J401, Lexington, KY 40536-0001 | 2017-04-17 |
| 1407397128 | Jordan Patrick Harp | Clinical Neuropsychologist | 740 S Limestone Ste B101, Lexington, KY 40536-0284 | 2017-03-14 |
| Find all providers in LEXINGTON | ||||
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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.