MS. LAURA GRACE MATLACK (PSY.D.) – Clinical Psychologist, NPI 1366698102

MS. LAURA GRACE MATLACK (PSY.D.) is a healthcare provider. based in Cambridge, Massachusetts. specializing in CLINICAL PSYCHOLOGIST. They hold the professional credentials PSY.D.. They hold a License No. 9366 (MA). The NPI Number for MS. LAURA GRACE MATLACK (PSY.D.) is 1366698102

Main info

Female
Sole Proprietor
16 Years Of Experience
Accepts Medicare Assignment
Name
MS. LAURA GRACE MATLACK (PSY.D.)
NPI
1366698102
Phone
(617) 686-1392
Address
16 MAGNOLIA AVE # 1
Enumeration Date
12 August 2008
Last Update Date
19 August 2011

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7812354950
Graduation Year
2010 (16 years ago)
PAC ID
6800336371
Group Practice PAC ID
7517909526
Professional Enrollment ID
I20240911000796
Address ID
MA024813130WE11XXXPLXX300
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience48
Completeness75
Years active:17State licenses:1Digital endpointsOther names

1,694 CLINICAL PSYCHOLOGIST in MA

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Provider Addresses for MS. LAURA GRACE MATLACK (PSY.D.)

  • 16 1/2, Magnolia Avenue, Inman Square, Cambridge, Middlesex County, Massachusetts, 02138-3824, United States

    CAMBRIDGE, MA 021383217

    Phone: (617) 686-1392

    Type: Mailing

  • 11, Chapel Place, Wellesley Farms, Wellesley, Norfolk County, Massachusetts, 02481-3120, United States

    WELLESLEY, MA 024813130

    Phone: (781) 235-4950

    Type: Location

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.

This can happen when there are no reportable CMS Open Payments records.

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: 2024-09-11

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240911000796IClinical PsychologistMATBD

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.

Verify on CMS Revalidation Lookup Tool

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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 02138)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 7517909526View full group profile
NameSpecialtyState
Clinical Social WorkerMA
Clinical PsychologistMA
Clinical PsychologistMA
P S Y C H I A T R YMA
Clinical PsychologistMA
Clinical Social WorkerMA
Clinical PsychologistMA
Clinical Social WorkerMA

Reviews

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Frequently asked questions

What unique ID ties claims to MS. LAURA GRACE MATLACK (PSY.D.)?
NPI 1366698102 is assigned to MS. LAURA GRACE MATLACK (PSY.D.) under the national enumeration system.
Is MS. LAURA GRACE MATLACK (PSY.D.)'s NPI currently valid?
The extract we use shows MS. LAURA GRACE MATLACK (PSY.D.) as active.
What kind of provider is MS. LAURA GRACE MATLACK (PSY.D.)?
The page reflects Clinical Psychologist for MS. LAURA GRACE MATLACK (PSY.D.). Clinical services aligned with this taxonomy classification.
Where does public data place MS. LAURA GRACE MATLACK (PSY.D.)?
The snapshot lists Cambridge, Massachusetts for MS. LAURA GRACE MATLACK (PSY.D.); download NPPES for the complete set.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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