Active NPI
Michael John Mullahy
- Addiction (Substance Use Disorder) Counselor
- Brookline, MA
National Provider Identifier
1245003193
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 23189
- Practice address
- 57 Harvard Ave Apt 1
Brookline, MA 02446-6223 - Phone
- (857) 867-9171
- NPI assigned
- Nov 2, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 003550 | ZZ | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 23189 | MA | Primary |
Addresses
Primary practice location
57 Harvard Ave Apt 1
Brookline, MA 02446-6223
Mailing address
57 Harvard Ave Apt 1
Brookline, MA 02446-6223
Phone (857) 867-9171
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003550 | ZZ | MD | Mental Health Counselor |
| 23189 | MA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1698883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698883200000",
"number": "1245003193",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "57 HARVARD AVE APT 1",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024466223",
"telephone_number": "857-867-9171"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "57 HARVARD AVE APT 1",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024466223",
"telephone_number": "857-867-9171"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLAHY",
"first_name": "MICHAEL",
"middle_name": "JOHN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-11-02",
"last_updated": "2023-11-02",
"certification_date": "2023-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "ZZ",
"license": "003550",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MA",
"license": "23189",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brookline, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.