NPIMap

Organization Active NPI

Cory Cove Wellness LLC

  • Group Psychotherapy Psychologist
  • Auburn, MA
National Provider Identifier
1235709817
Registry record updated Jun 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Group Psychotherapy PsychologistTaxonomy code 103TP2701X
Legal business name
CORY COVE WELLNESS LLC
Practice address
41 Highland St
Auburn, MA 01501-2035
Phone
(774) 432-3063
NPI assigned
Jun 28, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2021

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

Authorized official

Name
Kasey PendexterNPI 1992084321
Title
Owner
Phone
(774) 432-3063

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
Group Psychotherapy PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TP2701X Primary

Addresses

Primary practice location

41 Highland St
Auburn, MA 01501-2035

Mailing address

41 Highland St
Auburn, MA 01501-2035
Phone (774) 432-3063

Other identifiers 1

IdentifierTypeStateIssuer
1992084321MedicaidMA

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL www.gmail.com Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1624838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624838400000",
    "number": "1235709817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 HIGHLAND ST",
            "city": "AUBURN",
            "state": "MA",
            "postal_code": "015012035",
            "telephone_number": "774-432-3063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 HIGHLAND ST",
            "city": "AUBURN",
            "state": "MA",
            "postal_code": "015012035",
            "telephone_number": "774-432-3063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORY COVE WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-28",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-28",
        "status": "A",
        "authorized_official_last_name": "PENDEXTER",
        "authorized_official_first_name": "KASEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "774-432-3063"
    },
    "taxonomies": [
        {
            "code": "103TP2701X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992084321",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.gmail.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "EMR",
            "address_1": "41 Highland St",
            "city": "Auburn",
            "state": "MA",
            "country_code": "US",
            "postal_code": "015012035",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Auburn, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2021; 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.