Active NPI
Teresa Phelan
- Peer Specialist
- Worcester, MA
National Provider Identifier
1275143646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 0148RC
- Practice address
- Umass Memorial Medical Center
55 Lake Avenue North, Psychiatry
Worcester, MA 01655 - Phone
- (508) 334-1000
- NPI assigned
- Jul 31, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 0148RC | MA | Primary |
Addresses
Primary practice location
Umass Memorial Medical Center
55 Lake Avenue North, Psychiatry
Worcester, MA 01655
Mailing address
Umass Memorial Medical Center
55 Lake Avenue North, Psychiatry
Worcester, MA 01655
Phone (508) 334-1000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0148RC | Other | MA | RECOVERY COACH CERTIFICATION |
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 |
|---|---|---|---|
| 0148RC | MA | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596153600000",
"number": "1275143646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "UMASS MEMORIAL MEDICAL CENTER",
"address_2": "55 LAKE AVENUE NORTH, PSYCHIATRY",
"city": "WORCESTER",
"state": "MA",
"postal_code": "01655",
"telephone_number": "508-334-1000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "UMASS MEMORIAL MEDICAL CENTER",
"address_2": "55 LAKE AVENUE NORTH, PSYCHIATRY",
"city": "WORCESTER",
"state": "MA",
"postal_code": "01655",
"telephone_number": "508-334-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHELAN",
"first_name": "TERESA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-31",
"last_updated": "2020-07-31",
"certification_date": "2020-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "MA",
"license": "0148RC",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RECOVERY COACH CERTIFICATION",
"identifier": "0148RC",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.