Individual provider Active NPI

Traci Connor, LMHC

  • Mental Health Counselor
  • Andover, MA
National Provider Identifier
1174668313
Registry record updated Apr 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
LMHC7792 Issued in MA
Practice address
78 Main St
Andover, MA 01810-3851
Phone
(978) 273-2233
NPI assigned
Feb 21, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 2994 NH
Mental Health Counselor 101YM0800X LMHC7792 MA Primary

Addresses

Primary practice location

78 Main St
Andover, MA 01810-3851

Mailing address

45 Chandler Rd
Andover, MA 01810-2828
Phone (978) 409-2058

Other practice location 1

439 S Union St
Lawrence, MA 01843-2837
Phone (978) 681-9410

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20260108000356 MA Practitioner - Mental Health Counselor 8527544774 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2009
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1 Optum Cir
Eden Prairie, MN 55344-2956

40 Shattuck Rd
Suite 250
Andover, MA 01810-2492

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LMHC7792MAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Behavioral Care of Connecticut, P.C. CurrentSince Oct 2, 2025 Accepting new patients
Optum Behavioral Care of Connecticut, P.C. CurrentSince Oct 2, 2025 Accepting new patients

Locations

40 Shattuck Rd
Ste 250
Andover, MA 01810
Phone (978) 254-4116

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": "1172016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744156800000",
    "number": "1174668313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 CHANDLER RD",
            "city": "ANDOVER",
            "state": "MA",
            "postal_code": "018102828",
            "telephone_number": "978-409-2058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78 MAIN ST",
            "city": "ANDOVER",
            "state": "MA",
            "postal_code": "018103851",
            "telephone_number": "978-273-2233"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "439 S Union St",
            "address_purpose": "LOCATION",
            "city": "Lawrence",
            "state": "MA",
            "postal_code": "018432837",
            "country_code": "US",
            "telephone_number": "978-681-9410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CONNOR",
        "first_name": "TRACI",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-21",
        "last_updated": "2025-04-09",
        "certification_date": "2025-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NH",
            "license": "2994",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "LMHC7792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Andover, MA

Sources for this page

Verify at the official NPI Registry.