Active NPI
Maxine Sushelsky, LMHC
- Mental Health Counselor
- Waltham, MA
National Provider Identifier
1114065794
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 6658
- Practice address
- 169 Elm St
Waltham, MA 02453-5356 - Phone
- (781) 894-8440
- Fax
- (781) 894-1202
- NPI assigned
- Feb 3, 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 | 6658 | MA | Primary |
Addresses
Primary practice location
169 Elm St
Waltham, MA 02453-5356
Mailing address
PO Box 1182
Watertown, MA 02471-1182
Phone (617) 923-2882
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6658 | MA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223424000000",
"number": "1114065794",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1182",
"city": "WATERTOWN",
"state": "MA",
"postal_code": "024711182",
"telephone_number": "617-923-2882",
"fax_number": "617-923-2162"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "169 ELM ST",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024535356",
"telephone_number": "781-894-8440",
"fax_number": "781-894-1202"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUSHELSKY",
"first_name": "MAXINE",
"name_prefix": "Ms.",
"credential": "LMHC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-03",
"last_updated": "2008-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MA",
"license": "6658",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waltham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.