| NPI Number | 1124186986 |
| Provider Name | Thomas Chiodetti |
| Credential | |
| Specialization | |
| Medical School Name | Other |
| Graduation Year | 1993 |
| Gender | M |
| Entity Type | Individual |
| PAC ID by PECOS | 3870684111 |
| Professional Enrollment ID | I20070801000309 |
| Enumeration Date | 12/05/2006 |
| Last Update Date | 07/08/2007 |
| Business Practice address |
350 GIFFORD ST, Falmouth, 02540-2918 Massachusetts View on Google Map |
| Business Practice phone | 508-457-7222 |
| Business Practice fax | 508-540-5148 |
| Mailing address |
350 GIFFORD ST, Falmouth, 02540-2918 Massachusetts View on Google Map |
| Other phone | 508-457-7222 |
| Other fax | 508-540-5148 |
| Email Address | shannonfig@domain.com Reval Email Address |
Practices in Falmouth
Falmouth, Massachusetts
Other
1993
| Organization Name | PECOS PAC ID | Members | |
|---|---|---|---|
|
Advanced Psych Services Llc | 2961667498 | 14 |
| Field Name | Field Value |
|---|---|
| NPI | 1124186986 |
| 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. | |
| Entity Type | Individual |
Code describing the type of health care provider that is being assigned an NPI. Codes are:
|
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| Is Sole Proprietor | Y |
Indicate whether provider is a sole proprietor.
|
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| Provider Last Name (Legal Name) | Chiodetti |
| The last name of the provider (if an individual). If the provider is an individual, this is the legal name. This name must match the name on file with the Social Security Administration (SSA). In addition, the date of birth must match that on file with SSA. (First and last names are required for initial applications.) The First, Middle, Last and Credential(s) fields allow the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. | |
| Provider First Name | Thomas |
| The first name of the provider, if the provider is an individual. | |
| Provider Credential Text | ED.D. |
| The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS. | |
| Provider First Line Business Mailing Address | 350 GIFFORD ST |
| The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''. | |
| Provider Business Mailing Address City Name | Falmouth |
| The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''. | |
| Provider Business Mailing Address State Name | Massachusetts |
| The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''. | |
| Provider Business Mailing Address Postal Code | 02540-2918 |
| The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''. | |
| Provider Business Mailing Address Country Code | US |
| The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''. | |
| Provider Business Mailing Address Telephone Number | 508-457-7222 |
| The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number''. | |
| Provider Business Mailing Address Fax Number | 508-540-5148 |
| The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address fax number''. | |
| Provider First Line Business Practice Location Address | 350 GIFFORD 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 Business Practice Location Address City Name | Falmouth |
| The city name in the location address of the provider being identified. | |
| Provider Business Practice Location Address State Name | Massachusetts |
| The State or Province name in the location address of the provider being identified. | |
| Provider Business Practice Location Address Postal Code | 02540-2918 |
| 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 | US |
| The country code in the location address of the provider being identified. | |
| Provider Business Practice Location Address Telephone Number | 508-457-7222 |
| The telephone number associated with the location address of the provider being identified. | |
| Provider Business Practice Location Address Fax Number | 508-540-5148 |
| The fax number associated with the location address of the provider being identified. | |
| Provider Enumeration Date | 12/05/2006 |
| The date the provider was assigned a unique identifier (assigned an NPI). | |
| Last Update Date | 07/08/2007 |
| The date that a record was last updated or changed. | |
| Provider Gender Code | M |
| The code designating the provider's gender if the provider is a person. | |
| Provider Gender | Male |
| The provider's gender if the provider is a person. | |
| Healthcare Provider Taxonomy Code #1 | 103T00000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 1 | 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. |
| Healthcare Provider Taxonomy #1 | |
| Provider License Number 1 | PSYCHOLOGIST6705 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 1 | MA |
| Provider License Number State Code #1 | |
| Healthcare Provider Primary Taxonomy Switch 1 | X |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #2 | 103TA0400X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 2 | A psychologist with a proficiency that involves the application of psychological treatment of addiction stemming from the use of alcohol and other psychoactive substances (e.g., nicotine, marijuana, cocaine, heroin) or behavioral addictions (e.g., gambling) with the aim of cessation or reduction of use and/or the amelioration of emotional, behavioral, interpersonal and other problems arising from the addictive behavior. |
| Healthcare Provider Taxonomy #2 | |
| Provider License Number 2 | PSYCHOLOGIST6705 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 2 | MA |
| Provider License Number State Code #2 | |
| Healthcare Provider Primary Taxonomy Switch 2 | X |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #3 | 103TA0700X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 3 | A psychologist who specializes in geropsychology, which applies the knowledge and methods of psychology to understanding and helping older persons and their families to maintain well-being, overcome problems and achieve maximum potential during later life. Professional geropsychology appreciates the wide diversity among older adults, the complex ethical issues that can arise in geriatric practice and the importance of interdisciplinary models of care. |
| Healthcare Provider Taxonomy #3 | |
| Provider License Number 3 | PSYCHOLOGIST6705 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 3 | MA |
| Provider License Number State Code #3 | |
| Healthcare Provider Primary Taxonomy Switch 3 | X |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #4 | 103TC1900X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 4 | A psychologist who specializes in general practice and health service. It focuses on how people function both personally and in their relationships at all ages. Counseling psychology addresses the emotional, social, work, school and physical health concerns people may have at different stages in their lives, focusing on typical life stresses and more severe issues with which people may struggle as individuals and as a part of families, groups and organizations. Counseling psychologists help people with physical, emotional and mental health issues improve their sense of well-being, alleviate feelings of distress and resolve crises. They also provide assessment, diagnosis, and treatment of more severe psychological symptoms. |
| Healthcare Provider Taxonomy #4 | |
| Provider License Number 4 | PSYCHOLOGIST6705 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 4 | MA |
| Provider License Number State Code #4 | |
| Healthcare Provider Primary Taxonomy Switch 4 | X |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #5 | 103TC2200X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 5 | A psychologist who develops and applies scientific knowledge to the delivery of psychological services to infants, toddlers, children and adolescents within their social context. Of particular importance to the specialty of clinical child psychology is an understanding of the basic psychological needs of children and adolescents, and how the family and other social contexts influence the socio-emotional adjustment, cognitive development, behavioral adaptation and health status of children and adolescents. |
| Healthcare Provider Taxonomy #5 | |
| Provider License Number 5 | PSYCHOLOGIST6705 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 5 | MA |
| Provider License Number State Code #5 | |
| Healthcare Provider Primary Taxonomy Switch 5 | X |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #6 | 103TE1100X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 6 | A psychologist with a proficiency in sports psychology that uses psychological knowledge and skills to address optimal performance and well-being of athletes, developmental and social aspects of sports participation, and systemic issues associated with sports settings and organizations. APA recognizes sport psychology as a proficiency acquired after a doctoral degree in one of the primary areas of psychology and licensure as a psychologist. This proficiency does not include those who have earned a doctoral degree in sport psychology but are not licensed psychologists. Sport Psychology interventions are designed to assist athletes and other sports participants (e.g., coaches, administrators, parents) from a wide array of settings, levels of competition, and ages, ranging from recreational youth participants to professional and Olympic athletes to master's level performers. |
| Healthcare Provider Taxonomy #6 | |
| Provider License Number 6 | PSYCHOLOGIST6705 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 6 | MA |
| Provider License Number State Code #6 | |
| Healthcare Provider Primary Taxonomy Switch 6 | X |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #7 | 103TF0000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 7 | A psychologist whose specialty is founded on principles of systems theory with the interpersonal system of the family the focus of assessment, intervention and research. |
| Healthcare Provider Taxonomy #7 | |
| Provider License Number 7 | PSYCHOLOGIST6705 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 7 | MA |
| Provider License Number State Code #7 | |
| Healthcare Provider Primary Taxonomy Switch 7 | X |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #8 | 103TF0000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 8 | A psychologist whose specialty is founded on principles of systems theory with the interpersonal system of the family the focus of assessment, intervention and research. |
| Healthcare Provider Taxonomy #8 | |
| Provider License Number 8 | PSYCHOLOGIST6705 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 8 | MA |
| Provider License Number State Code #8 | |
| Healthcare Provider Primary Taxonomy Switch 8 | X |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #9 | 103TS0200X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 9 | A psychologist whose specialty is concerned with the science and practice of psychology with children, youth, families; learners of all ages; and the schooling process. The basic education and training of school psychologists prepares them to provide a range of psychological diagnosis, assessment, intervention, prevention, health promotion, and program development and evaluation services with a special focus on the developmental processes of children and youth within the context of schools, families and other systems. School psychologists are prepared to intervene at the individual and system level, and develop, implement, and evaluate preventive programs. In these efforts, they conduct ecologically valid assessments and intervene to promote positive learning environments within which children and youth from diverse backgrounds to ensure that all have equal access to effective educational and psychological services that promote healthy development |
| Healthcare Provider Taxonomy #9 | |
| Provider License Number 9 | PSYCHOLOGIST6705 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 9 | MA |
| Provider License Number State Code #9 | |
| Healthcare Provider Primary Taxonomy Switch 9 | X |
Primary Taxonomy:
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