NPIMap

Organization Active NPI

Engrace Behavioral Health Services LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Randolph, MA
National Provider Identifier
1013416387
Registry record updated Mar 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
ENGRACE BEHAVIORAL HEALTH SERVICES LLC
Practice address
950 N Main St # 202
Randolph, MA 02368-3064
Phone
(617) 203-2009
NPI assigned
Feb 1, 2018
Last updated
Mar 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2024

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

Authorized official

Name
Juliana IgbinosunNPI 1417468463
Title
NP
Phone
(617) 203-2009

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 Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Primary Care Clinic/Center 261QP2300X
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

950 N Main St # 202
Randolph, MA 02368-3064

Mailing address

950 N Main St # 202
Randolph, MA 02368-3064
Phone (617) 203-2009

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, CT, MD3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20180525000621 MA Part B Supplier - Clinic/Group Practice 7214292069 Receives reassigned benefits from 9 practitioners
Practice locations: Randolph, MA
O20241227001113 CT Part B Supplier - Clinic/Group Practice 7214292069 Receives reassigned benefits from 2 practitioners
Practice locations: Windsor, CT
O20250103000359 MD Part B Supplier - Clinic/Group Practice 7214292069 Receives reassigned benefits from 1 practitioner
Practice locations: Annapolis, MD

National Provider Directory

National Provider Directory

Locations

175 Addison Rd
Fl 1
Windsor, CT 06095
Phone (516) 605-5236

1223 Beacon St
Ste A
Brookline, MA 02446
Phone (617) 232-7400

950 N Main St
#202
Randolph, MA 02368
Phone (617) 203-2009

950 N Main St
Ste 202
Randolph, MA 02368
Phone (617) 203-2009

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1517443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710201600000",
    "number": "1013416387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 N MAIN ST # 202",
            "city": "RANDOLPH",
            "state": "MA",
            "postal_code": "023683064",
            "telephone_number": "617-203-2009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 N MAIN ST # 202",
            "city": "RANDOLPH",
            "state": "MA",
            "postal_code": "023683064",
            "telephone_number": "617-203-2009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENGRACE BEHAVIORAL HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-01",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A",
        "authorized_official_last_name": "IGBINOSUN",
        "authorized_official_first_name": "JULIANA",
        "authorized_official_title_or_position": "NP",
        "authorized_official_telephone_number": "617-203-2009"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Randolph, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2024; 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.