NPIMap

Organization Active NPI

Footprints Mental Health Counseling, P. C.

  • Mental Health Counselor
  • Bronx, NY
National Provider Identifier
1033724414
Registry record updated Nov 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
FOOTPRINTS MENTAL HEALTH COUNSELING, P. C.
Practice address
3249 Kingsbridge Ave
Bronx, NY 10463-5514
Phone
(646) 204-2295
Fax
(347) 332-4145
NPI assigned
Sep 11, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2022

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

Authorized official

Name
Danielle Luz MatiasNPI 1417372160
Title
Clinical Administrator
Phone
(646) 204-2295

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

3249 Kingsbridge Ave
Bronx, NY 10463-5514

Mailing address

3249 Kingsbridge Ave
Bronx, NY 10463-5514
Phone (929) 330-1065

Other practice location 1

3033 Godwin Ter Apt 4C
Bronx, NY 10463-5344
Phone (929) 330-1065

Other practice location 2

1060 Broadway
Menands, NY 12204-2507
Phone (646) 204-2295

Other practice location 3

8810 Fox Dr
Polk City, FL 33868-6024
Phone (646) 204-2295

Other practice location 4

377 Valley Rd # 1154
Clifton, NJ 07013-1319
Phone (646) 204-2295

Other names 1

  • Feel Better Therapy Clinic Former legal business name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address FeelBetterTherapyClinic@outlook.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210409000136 NJ Part B Supplier - Clinic/Group Practice 2163836370 Receives reassigned benefits from 2 practitioners
Practice locations: Clifton, NJ

National Provider Directory

National Provider Directory

Locations

377 Valley Rd
Ste 1154
Clifton, NJ 07013

377 Valley Rd
#1154
Clifton, NJ 07013

1060 Broadway
Menands, NY 12204

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1599782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667260800000",
    "number": "1033724414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3249 KINGSBRIDGE AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104635514",
            "telephone_number": "929-330-1065",
            "fax_number": "347-332-4145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3249 KINGSBRIDGE AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104635514",
            "telephone_number": "646-204-2295",
            "fax_number": "347-332-4145"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3033 Godwin Ter Apt 4C",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104635344",
            "country_code": "US",
            "telephone_number": "929-330-1065",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1060 Broadway",
            "address_purpose": "LOCATION",
            "city": "Menands",
            "state": "NY",
            "postal_code": "122042507",
            "country_code": "US",
            "telephone_number": "646-204-2295",
            "fax_number": "347-332-4145",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8810 Fox Dr",
            "address_purpose": "LOCATION",
            "city": "Polk City",
            "state": "FL",
            "postal_code": "338686024",
            "country_code": "US",
            "telephone_number": "646-204-2295",
            "fax_number": "347-332-4145",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "377 Valley Rd # 1154",
            "address_purpose": "LOCATION",
            "city": "Clifton",
            "state": "NJ",
            "postal_code": "070131319",
            "country_code": "US",
            "telephone_number": "646-204-2295",
            "fax_number": "347-332-4145",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FOOTPRINTS MENTAL HEALTH COUNSELING, P. C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-11",
        "last_updated": "2022-11-01",
        "certification_date": "2022-11-01",
        "status": "A",
        "authorized_official_last_name": "MATIAS",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_middle_name": "LUZ",
        "authorized_official_title_or_position": "CLINICAL ADMINISTRATOR",
        "authorized_official_telephone_number": "646-204-2295"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "FeelBetterTherapyClinic@outlook.com",
            "affiliation": "N",
            "endpointDescription": "Office Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3033 Godwin Ter Apt 4C",
            "city": "Bronx",
            "state": "NY",
            "country_code": "US",
            "postal_code": "104635344",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Feel Better Therapy Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2022; 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.