NPIMap

Organization Active NPI

Marblehead Counseling Center Inc

  • Counselor
  • Marblehead, MA
National Provider Identifier
1205915857
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Legal business name
MARBLEHEAD COUNSELING CENTER INC
Practice address
66 Clifton Ave
Marblehead, MA 01945
Phone
(781) 631-8273
Fax
(781) 631-7264
NPI assigned
Nov 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Paul Timothy Crosby, LICSW
Title
Executive Director
Phone
(781) 631-8273

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101Y00000X Primary

Addresses

Primary practice location

66 Clifton Ave
Marblehead, MA 01945

Mailing address

66 Clifton Ave
Marblehead, MA 01945
Phone (781) 631-8273

Other identifiers 1

IdentifierTypeStateIssuer
1307487MedicaidMA

Other names 1

  • Marblehead Community Counseling Center Inc Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040807000131 MA Part B Supplier - Clinic/Group Practice 2860464138 Receives reassigned benefits from 7 practitioners
Practice locations: Marblehead, MA

National Provider Directory

National Provider Directory

Locations

66 Clifton Ave
Marblehead, MA 01945
Phone (781) 631-8273

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205915857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 CLIFTON AVE",
            "city": "MARBLEHEAD",
            "state": "MA",
            "postal_code": "01945",
            "telephone_number": "781-631-8273",
            "fax_number": "781-631-7264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 CLIFTON AVE",
            "city": "MARBLEHEAD",
            "state": "MA",
            "postal_code": "01945",
            "telephone_number": "781-631-8273",
            "fax_number": "781-631-7264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARBLEHEAD COUNSELING CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CROSBY",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "TIMOTHY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "781-631-8273",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1307487",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marblehead Community Counseling Center Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Marblehead, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.