DR. KENNETH PARK (PHD) – Clinical Psychologist, NPI 1457392912
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 PARK (PHD)
486 LOWELL ST
LEXINGTON, MA 024202241
Phone: (617) 398-7297
Type: Location
137-141, Newbury Street, Back Bay, Boston, Suffolk County, Massachusetts, 02116, United States
6TH FLOOR
BOSTON, MA 021162912
Phone: (617) 398-7297
Type: Location
15;17, Myrtle Street, Watertown, Middlesex County, Massachusetts, 02172, United States
WATERTOWN, MA 024722371
Phone: (617) 797-8764
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: 2005-12-05
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 |
|---|---|---|---|---|
| I20051205000572 | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 02420)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| G A S T R O E N T E R O L O G Y | MA | |
| Internal Medicine | MA | |
| - | MA | |
| - | MA | |
| Anesthesiology, Pain Management | MA | |
| - | MA | |
| Clinical Psychologist | MA | |
| Internal Medicine | MA | |
| Internal Medicine | MA | |
| - | MA |
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