Individual provider Active NPI

Ellen Jane Freshman

  • Mental Health Counselor
  • Worcester, MA
National Provider Identifier
1154602936
Registry record updated Sep 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
255 Park Ave
Worcester, MA 01609-1953
Phone
(508) 799-0688
NPI assigned
Sep 7, 2011
Last updated
Sep 7, 2011By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 7, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU Primary

Addresses

Primary practice location

255 Park Ave
Worcester, MA 01609-1953

Mailing address

255 Park Ave
Worcester, MA 01609-1953
Phone (508) 799-0688

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240118004424 MA Practitioner - Mental Health Counselor 5496669525 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Eliot Community Human Services CurrentSince Jan 1, 2024 Accepting new patients
Eliot Community Human Services CurrentSince Jan 1, 2024 Accepting new patients

Locations

86 Baker Avenue Ext
Ste 100
Concord, MA 01742
Phone (978) 202-4156

125 Hartwell Ave
Lexington, MA 02421
Phone (781) 734-2060

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1315353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315353600000",
    "number": "1154602936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 PARK AVE",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016091953",
            "telephone_number": "508-799-0688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 PARK AVE",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016091953",
            "telephone_number": "508-799-0688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRESHMAN",
        "first_name": "ELLEN",
        "middle_name": "JANE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-07",
        "last_updated": "2011-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.