DR. KENNETH I WILSON (PSY.D.) – Clinical Psychologist, NPI 1194785287
Clinical Psychologist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,694 CLINICAL PSYCHOLOGIST in MA
Provider Addresses for DR. KENNETH I WILSON (PSY.D.)
22 Mill St
Suite 004
Arlington, MA 024764784
Phone: (781) 646-0500
Fax: (781) 646-7130
Type: Location
12 ALFRED ST STE 200
WOBURN, MA 018011915
Phone: (781) 646-0500
Fax: (781) 646-7130
Type: Mailing
Dental Associates of Arlington, 22, Mill Street, Alta Brigham Square, Arlington, Middlesex County, Massachusetts, 02476, United States
SUITE 004
ARLINGTON, MA 024764784
Phone: (781) 646-0500
Fax: (781) 646-7130
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-04-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20040413001076 | I | Clinical Psychologist | MA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 90834 | Psychotherapy, 45 minutes | 373 | 20 | $0 |
Insurance plans in this area (ZIP 02476)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Clinical Social Worker | MA | |
| - | MA | |
| - | MA | |
| - | MA | |
| - | MA | |
| - | MA | |
| - | MA | |
| - | MA | |
| Clinical Social Worker | MA | |
| Mental Health Counselor | MA |
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