Chanel Viviana Tazza, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

5913 Grove St
Ridgewood, NY 11385-2647

Phone

(646) 456-0819

Fax

(718) 297-8658

NPI assigned

Jul 16, 2007

Last updated

Mar 28, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Transitional Services for New York, Inc.Group PAC ID 7719932540, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kandisf@awakenwellnessnyc.kareodirect.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Chanel V. Tazza, Mental Health Counseling, P.C.

  dba Awaken Wellness

  • Mental Health Counselor
  • Glen Head, NY
  • NPI 1386114692
  Medicare reassignment NPD Authorized official
• Transitional Services for New York, Inc

  • Community/Behavioral Health Agency
  • Jamaica, NY
  • NPI 1457418337
  Medicare reassignment Care Compare group NPD
• Brooklyn Center for Psychotherapy,Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Brooklyn, NY
  • NPI 1275516213
  NPD (past)
• Transitional Services for New York,Inc.

  • Community/Behavioral Health Agency
  • Jamaica, NY
  • NPI 1861644148
  NPD (past)

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

{
    "created_epoch": "1184544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711584000000",
    "number": "1053510354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 SCUDDERS LN",
            "city": "GLEN HEAD",
            "state": "NY",
            "postal_code": "115451535",
            "telephone_number": "646-456-0819",
            "fax_number": "718-297-8658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5913 GROVE ST",
            "city": "RIDGEWOOD",
            "state": "NY",
            "postal_code": "113852647",
            "telephone_number": "646-456-0819",
            "fax_number": "718-297-8658"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "63 Scudders Ln",
            "address_purpose": "LOCATION",
            "city": "Glen Head",
            "state": "NY",
            "postal_code": "115451535",
            "country_code": "US",
            "telephone_number": "646-456-0819",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAZZA",
        "first_name": "CHANEL",
        "middle_name": "VIVIANA",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-16",
        "last_updated": "2024-03-28",
        "certification_date": "2024-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "004161",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS MENTAL HEALTH COUNSELOR LICENSE",
            "identifier": "00-4161",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "006801",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "37PC00991600",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07679601",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1053510354",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Medhat Kamal Tadrous
• Alvaro Tamayo Gutierrez, M.D.
• Liza Tan, PT, DPT, MA
• Vito Frank Taverna, M.D.
• Phillip Austin Taylor
• Stela Teferici, MD
• Rachel Michelle Teichman
• Nino Tevdorashvili, LMHC
• Sushila Thapa Raut
• The Augury for Women's Health Medical PLLC

• Mental Health Counselor in Ridgewood, NY
• Providers in Ridgewood, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.