NPIMap

Organization Active NPI

Blackbird Counseling

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Pembroke, MA
National Provider Identifier
1215511332
Registry record updated Jan 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
BLACKBIRD COUNSELING
Practice address
28 Riverside Dr Ste 270
Pembroke, MA 02359-4947
Phone
(774) 773-6300
NPI assigned
May 6, 2021
Last updated
Jan 25, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
BLACKBIRD COUNSELING LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 25, 2022

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

Authorized official

Name
Justine Carlucci, LMFTNPI 1699114934
Title
Program Director
Phone
(339) 235-5116

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary

Addresses

Primary practice location

28 Riverside Dr Ste 270
Pembroke, MA 02359-4947

Mailing address

28 Riverside Dr Ste 270
Pembroke, MA 02359-4947
Phone (774) 773-6300

National Provider Directory

National Provider Directory
Tax ID family
Blackbird Counseling2 organizations share this tax ID, including this one
Part of
Blackbird Counseling

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1620259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643068800000",
    "number": "1215511332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 RIVERSIDE DR STE 270",
            "city": "PEMBROKE",
            "state": "MA",
            "postal_code": "023594947",
            "telephone_number": "774-773-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 RIVERSIDE DR STE 270",
            "city": "PEMBROKE",
            "state": "MA",
            "postal_code": "023594947",
            "telephone_number": "774-773-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKBIRD COUNSELING",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BLACKBIRD COUNSELING LLC",
        "enumeration_date": "2021-05-06",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A",
        "authorized_official_last_name": "CARLUCCI",
        "authorized_official_first_name": "JUSTINE",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "339-235-5116",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2022; 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.