Active NPI
Kacey Rose Bongarzone, MA, LMHC, ATR
- Mental Health Counselor
- Hingham, MA
National Provider Identifier
1194006239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 8811
- Practice address
- 175 Derby St Ste 10
Hingham, MA 02043-4028 - Phone
- (617) 302-7814
- NPI assigned
- Sep 2, 2011
- Reactivated
- Feb 5, 2016
- Last updated
- Jun 10, 2019
- 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 | 8811 | MA | Primary |
Addresses
Primary practice location
175 Derby St Ste 10
Hingham, MA 02043-4028
Mailing address
175 Derby St Ste 10
Hingham, MA 02043-4028
Phone (617) 302-7814
Other practice location 1
1115 West Chestnut St.
South Bay Mental Health
Brockton, MA 02301-7501
Phone (508) 580-4691 ext. 686
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 12, 2026 through Mar 12, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Jamaica Plain, MA
- NPI 1326412685
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560124800000",
"number": "1194006239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "175 DERBY ST STE 10",
"city": "HINGHAM",
"state": "MA",
"postal_code": "020434028",
"telephone_number": "617-302-7814"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "175 DERBY ST STE 10",
"city": "HINGHAM",
"state": "MA",
"postal_code": "020434028",
"telephone_number": "617-302-7814"
}
],
"practiceLocations": [
{
"address_1": "1115 West Chestnut St.",
"address_2": "South Bay Mental Health",
"address_purpose": "LOCATION",
"city": "Brockton",
"state": "MA",
"postal_code": "023017501",
"country_code": "US",
"telephone_number": "508-580-4691 x686",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BONGARZONE",
"first_name": "KACEY",
"middle_name": "ROSE",
"name_prefix": "Ms.",
"credential": "MA, LMHC, ATR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-02",
"last_updated": "2019-06-10",
"deactivation_date": "2014-02-13",
"reactivation_date": "2016-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MA",
"license": "8811",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hingham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.