Active NPI
Laura J. Polvino, M.A., LMHC
- Mental Health Counselor
- Southborough, MA
National Provider Identifier
1083805402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 5212
- Practice address
- 24 Newton St
Southborough, MA 01772-1215 - Phone
- (508) 481-5500
- Fax
- (508) 460-3025
- NPI assigned
- Aug 9, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 5212 | MA | Primary |
Addresses
Primary practice location
24 Newton St
Southborough, MA 01772-1215
Mailing address
24 Newton St
Southborough, MA 01772-1215
Phone (508) 481-5500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186617600000",
"number": "1083805402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24 NEWTON ST",
"city": "SOUTHBOROUGH",
"state": "MA",
"postal_code": "017721215",
"telephone_number": "508-481-5500",
"fax_number": "508-460-3025"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24 NEWTON ST",
"city": "SOUTHBOROUGH",
"state": "MA",
"postal_code": "017721215",
"telephone_number": "508-481-5500",
"fax_number": "508-460-3025"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLVINO",
"first_name": "LAURA",
"middle_name": "J.",
"credential": "M.A., LMHC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-09",
"last_updated": "2007-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MA",
"license": "5212",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southborough, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.