SOUTHBORO MEDICAL GROUP, INC. (NPI# 1518032630) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518032630 |
| Entity Type | Organization |
| Organization Name | SOUTHBORO MEDICAL GROUP, INC. |
| Practice Address |
24 Newton St Southborough MA 01772-1215 |
| Practice Telephone | 5084815500 |
| Practice Fax Number | 5084603025 |
| Mailing Telephone | 5084815500 |
| Mailing Fax Number | 5084603025 |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MARVIN OSTROVSKY (PRESIDENT) |
| Authorized Official Telephone | 5084815500 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 103T00000X | Psychologist | Behavioral Health & Social Service Providers | ||
| X | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | TUFTS BEHAVIORAL HEALTH | 669105 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578637724 | Southboro Medical Group, Inc. | Optometrist | 24 Newton St, Southborough, MA 01772-1215 | 2006-11-20 |
| 1568473635 | Southboro Medical Group, Inc. | Social Worker | 24 Newton St, Southborough, MA 01772-1215 | 2006-08-11 |
| Street Address |
24 NEWTON ST |
| City | SOUTHBOROUGH |
| State | MA |
| Zip Code | 01772-1215 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922094788 | Mark Finno, Md PC | Physical Medicine & Rehabilitation | 24 Newton St, Southborough, MA 01772-1215 | 2005-09-26 |
| 1649881699 | Jeremy Kw Spiewak | Pharmacist | 24 Newton St, Southborough, MA 01772-1215 | 2020-08-13 |
| 1437794716 | Reliant Medical Group, Inc | Optometrist | 24 Newton St, Southborough, MA 01772-1215 | 2019-11-11 |
| 1427516004 | Fnu Jomymerlythomas | Physical Therapist | 24 Newton St, Southborough, MA 01772-1215 | 2019-03-04 |
| 1629558960 | Amanda N Griffin | Nurse Practitioner | 24 Newton St, Southborough, MA 01772-1215 | 2018-08-16 |
| 1700322674 | Rosalind Gendreau | Registered Nurse | 24 Newton St, Southborough, MA 01772-1215 | 2017-01-16 |
| 1932584950 | Christine Ditullio | Nurse Practitioner | 24 Newton St, Southborough, MA 01772-1215 | 2015-07-21 |
| 1891175113 | Elizabeth Ann Minevich | Internal Medicine | 24 Newton St, Southborough, MA 01772-1215 | 2015-06-02 |
| 1164834750 | Southboro Medical Group, Inc | Specialist | 24 Newton St, Southborough, MA 01772-1215 | 2014-05-30 |
| 1588096754 | Shannon Leah Devlin | Registered Nurse | 24 Newton St, Southborough, MA 01772-1215 | 2013-07-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043854391 | Hiral Patel | Pharmacist | 150 Northnoro Road, Suite 4, Southborough, MA 01772 | 2019-10-30 |
| 1588188544 | Jennifer Foran | Behavior Technician | 33 Turnkpike Road, Southborough, MA 01772 | 2017-08-01 |
| 1588184402 | Lise Mary Gallo | Behavioral Analyst | 16 Clifford St, Southborough, MA 01772 | 2017-06-21 |
| 1437508322 | Kristen Lomker | Pharmacist | 155 Northborough Rd, Southboro, MA 01772 | 2016-06-10 |
| 1679841829 | Scott Adam Canter | Acupuncturist | 64 William Onthank Lane, Southborough, MA 01772 | 2011-12-02 |
| 1396966206 | Umer Sayeed Shah | Surgery | 2 Parkcentral Drive Suite 210, Avc / Acc, Southborough, MA 01772 | 2007-05-01 |
| 1982636411 | Armineh Mirzabegian | Internal Medicine | Southboro Medical Group, 24 Newton Street, Southboro, MA 01772 | 2006-07-07 |
| 1336197508 | Lisa M Hassler | Pediatrics | 24 Newton Street, Southboro Medical Group, Southboro, MA 01772 | 2006-05-04 |
| 1295714640 | Robin K Morgan | Physical Therapist | 28 Newton St, Southborough, MA 01772 | 2006-01-13 |
| 1528562998 | Emily Marie Bagley | Student in an Organized Health Care Education/Training Program | 33 Turnpike Rd, Southborough, MA 01772 | 2018-03-21 |
| Find all providers in zip 01772 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881614436 | Paul L. Mortarelli | Psychologist | 24 Newton St, Southborough, MA 01772-1215 | 2006-07-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578162798 | Psychological Transformation | Psychologist | 348 Cambridge Rd # 115, Woburn, MA 01801-6037 | 2020-10-19 |
| 1841897345 | Sade Callwood | Psychologist | 185 Devonshire St Ste 800, Boston, MA 02110-1414 | 2020-10-07 |
| 1982210480 | Aaron Rezendes Psyd LLC | Psychologist | 38 Dow St, Framingham, MA 01702-7220 | 2020-09-20 |
| 1184239808 | Morgan Eleanor Smigielski | Psychologist | 65 Park Dr Apt 18, Boston, MA 02215-5238 | 2020-09-10 |
| 1821601568 | Dr. Chelsea Levy Licensed Psychologist LLC | Psychologist | 203 Spring St, Medford, MA 02155-2814 | 2020-08-24 |
| 1679183230 | Holly Muller | Psychologist | 225 Friend St, Boston, MA 02114-1800 | 2020-08-07 |
| 1285242123 | Ruth Brim Balser | Psychologist | 36 Audubon Dr, Chestnut Hill, MA 02467-2621 | 2020-07-16 |
| 1952929184 | Sarah Joanna Schoffstall | Psychologist | 32 Hastings St, Framingham, MA 01701-7954 | 2020-07-14 |
| 1225655871 | Sasha Fleary | Psychologist | 28 Walter St, Hyde Park, MA 02136-2973 | 2020-06-30 |
| 1760008635 | Katherine Renda Florek | Psychologist | 2 Collins Rd, Hingham, MA 02043-2017 | 2020-06-17 |
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| City | SOUTHBOROUGH |
| Zip Code | 01772 |
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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.