NPIMap

Organization Active NPI

Blue Square Counseling and Wellness Center, PLLC

  • Psychologist
  • Billerica, MA
National Provider Identifier
1013331388
Registry record updated Nov 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
BLUE SQUARE COUNSELING AND WELLNESS CENTER, PLLC
Practice address
294 Concord Rd
Billerica, MA 01821-3482
Phone
(978) 330-5105
NPI assigned
Feb 7, 2014
Last updated
Nov 29, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gina Aguayo, PHDNPI 1821199225
Title
Owner
Phone
(978) 330-5105

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Psychologist 103T00000X Primary
Clinical Social Worker 1041C0700X

Addresses

Primary practice location

294 Concord Rd
Billerica, MA 01821-3482

Mailing address

294 Concord Rd
Billerica, MA 01821-3482

Other names 1

  • Bay State Counseling and Wellness Center, PLLC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230105000424 MA Part B Supplier - Clinic/Group Practice 2163892399 Receives reassigned benefits from 4 practitioners
Practice locations: Billerica, MA

National Provider Directory

National Provider Directory

Locations

294 Concord Rd
Billerica, MA 01821
Phone (978) 330-5105

572 Boston Rd
Unit 24
Billerica, MA 01821
Phone (781) 572-4550

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1391731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701216000000",
    "number": "1013331388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "294 CONCORD RD",
            "city": "BILLERICA",
            "state": "MA",
            "postal_code": "018213482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "294 CONCORD RD",
            "city": "BILLERICA",
            "state": "MA",
            "postal_code": "018213482",
            "telephone_number": "978-330-5105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE SQUARE COUNSELING AND WELLNESS CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-07",
        "last_updated": "2023-11-29",
        "certification_date": "2023-11-29",
        "status": "A",
        "authorized_official_last_name": "AGUAYO",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "978-330-5105",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bay State Counseling and Wellness Center, PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Billerica, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.