Active NPI
Courtney Baczko
- Mental Health Counselor
- Worcester, MA
National Provider Identifier
1285883462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 335 Chandler St
Worcester, MA 01602-3441 - Phone
- (508) 753-2967
- Fax
- (508) 767-3095
- NPI assigned
- Sep 12, 2008
- Last updated
- Sep 12, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 | NU | Primary |
Addresses
Primary practice location
335 Chandler St
Worcester, MA 01602-3441
Mailing address
335 Chandler St
Worcester, MA 01602-3441
Phone (508) 753-2967
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220720001378 | OR | Order and Referring Only - Clinical Social Worker | 4486971835 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221177600000",
"number": "1285883462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "335 CHANDLER ST",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016023441",
"telephone_number": "508-753-2967",
"fax_number": "508-767-3095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "335 CHANDLER ST",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016023441",
"telephone_number": "508-753-2967",
"fax_number": "508-767-3095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACZKO",
"first_name": "COURTNEY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-09-12",
"last_updated": "2008-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"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 Sep 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.