Individual provider Active NPI

Mallory Kroll

  • Mental Health Counselor
  • Waltham, MA
National Provider Identifier
1215374012
Registry record updated Jun 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
77 Rumford Ave
Waltham, MA 02453-3872
Phone
(781) 894-4307
NPI assigned
Jun 3, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 3, 2013

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 Primary

Addresses

Primary practice location

77 Rumford Ave
Waltham, MA 02453-3872

Mailing address

103 Bartlett Ave
# 1
Arlington, MA 02476-7951
Phone (973) 714-4522

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

NPI Registry JSON

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

{
    "created_epoch": "1370217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370217600000",
    "number": "1215374012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 BARTLETT AVE",
            "address_2": "# 1",
            "city": "ARLINGTON",
            "state": "MA",
            "postal_code": "024767951",
            "telephone_number": "973-714-4522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 RUMFORD AVE",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024533872",
            "telephone_number": "781-894-4307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KROLL",
        "first_name": "MALLORY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-06-03",
        "last_updated": "2013-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "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 Jun 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.