ADVANCED NEUROTHERAPY, PC — NPI 1104846476 (Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Cognitive & Behavioral in WELLESLEY, MA)

CMS-1500 Box 24J / 33a • NPI

1104846476

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

103TB0200X (CMS 62)

Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Cognitive & Behavioral

Box 32 Service Location & ZIP+4

140 BRISTOL RD, WELLESLEY, MA, 02481-2730

✓ 9-Digit EDI 837 ZIP+4 (02481-2730)

Practice Phone & Referral Fax

(781) 444-9115

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1104846476 (ADVANCED NEUROTHERAPY, PC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1104846476` (NPI-2 Organization / Facility)
Provider / Legal Name	ADVANCED NEUROTHERAPY, PC
Plain-English Specialty	Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Cognitive & Behavioral NUCC Code: `103TB0200X` (Psychologist, Cognitive & Behavioral)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	140 BRISTOL RD, WELLESLEY, MA, 02481-2730
Practice Telephone / Fax	Tel: (781) 444-9115
Administrative Mailing Address	10436 PARK TREE PL, GLEN ALLEN, VA, 23060-4487
Enumeration & Last Sync	Enumerated: 2006-07-20 \| CMS Record Updated: 2023-06-15
Authorized Official	JOLENE ROSS (Licensed Psychologist/Director)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

140 BRISTOL RD, WELLESLEY, MA, 02481-2730

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Plain-English Taxonomy & CMS Crosswalk (103TB0200X)

What Does Taxonomy Code 103TB0200X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 103TB0200X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Cognitive & Behavioral"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 62 (Psychologist, Clinical)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Psychologist, Cognitive & Behavioral for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ADVANCED NEUROTHERAPY, PC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`103TB0200X` — Psychologist, Cognitive & Behavioral Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Cognitive & Behavioral	State: MA \| License: `3976` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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ADVANCED NEUROTHERAPY, PC (NPI #1104846476)