Active NPI
Tabitha KB Heidorn
- Mental Health Counselor
- Lexington, MA
National Provider Identifier
1275818247
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 1040 Waltham St
Lexington, MA 02421-8033 - Phone
- (781) 761-5077
- NPI assigned
- Oct 20, 2011
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
1040 Waltham St
Lexington, MA 02421-8033
Mailing address
1040 Waltham St
Lexington, MA 02421-8033
Phone (781) 761-5077
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1303287 | Medicaid | MA | |
| 042611055 | Other | MA | TAX ID |
| 1303287 | Other | MA | MBHP |
| 1004745 | Other | MA | NHP |
| 0000023532 | Other | MA | BMC |
| 99618201 | Other | MA | NETWORK HEALTH |
| M18633 | Other | MA | BCBS |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Edinburg Center Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychiatry Physician
- Bedford, MA
- NPI 1073617353
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1319068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319068800000",
"number": "1275818247",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1040 WALTHAM ST",
"city": "LEXINGTON",
"state": "MA",
"postal_code": "024218033",
"telephone_number": "781-761-5077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1040 WALTHAM ST",
"city": "LEXINGTON",
"state": "MA",
"postal_code": "024218033",
"telephone_number": "781-761-5077"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEIDORN",
"first_name": "TABITHA",
"middle_name": "KB",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-20",
"last_updated": "2011-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1303287",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "042611055",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MBHP",
"identifier": "1303287",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NHP",
"identifier": "1004745",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BMC",
"identifier": "0000023532",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NETWORK HEALTH",
"identifier": "99618201",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "M18633",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lexington, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.