NPIMap

Organization Active NPI

Blackbird Counseling

  • Mental Health Counselor
  • Pembroke, MA
National Provider Identifier
1235746546
Registry record updated Jan 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
BLACKBIRD COUNSELING
Practice address
28 Riverside Dr Ste 270
Pembroke, MA 02359-4947
Phone
(774) 773-6300
NPI assigned
Sep 30, 2020
Last updated
Jan 25, 2022By the provider in NPPES
Organization subpart
No

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, MS, LMFTNPI 1699114934
Title
Co-Owner
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 Counselor 101YM0800X 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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260626002511 MA Part B Supplier - Clinic/Group Practice 6103399514 Receives reassigned benefits from 3 practitioners
Practice locations: Pembroke, MA

National Provider Directory

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

Other organizations with this tax ID 1

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

Locations

28 Riverside Dr
Ste 270
Pembroke, MA 02359
Phone (339) 235-5116

5 Main Street Ext
Ste 303
Plymouth, MA 02360
Phone (508) 591-0372

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 3

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": "1601424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643068800000",
    "number": "1235746546",
    "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": "NO",
        "enumeration_date": "2020-09-30",
        "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": "CO-OWNER",
        "authorized_official_telephone_number": "339-235-5116",
        "authorized_official_credential": "MS, LMFT"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "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.
  • 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.