Jeanne Mary Internicola

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

1915 Issued in MA

Practice address

210 Old Colony Ave
South Boston, MA 02127-2413

Phone

(617) 268-5000

NPI assigned

Feb 5, 2018

Last updated

Feb 5, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gavin Foundation

  • Clinic/Center
  • South Boston, MA
  • NPI 1396079414
  NPD (past)
• Gavin Foundation, Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Quincy, MA
  • NPI 1750895413
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1517788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517788800000",
    "number": "1306345483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 E 4TH ST",
            "city": "SOUTH BOSTON",
            "state": "MA",
            "postal_code": "021273063",
            "telephone_number": "617-268-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 OLD COLONY AVE",
            "city": "SOUTH BOSTON",
            "state": "MA",
            "postal_code": "021272413",
            "telephone_number": "617-268-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INTERNICOLA",
        "first_name": "JEANNE",
        "middle_name": "MARY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-05",
        "last_updated": "2018-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MA",
            "license": "1915",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "043220123",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathleen Hill, RPH
• Micaela Hill, OTD, OTR/L
• Courtney Elizabeth Hoban
• Rae R Huang, OD
• Ryan Frank Hurley
• Theresa Tara Johnson
• Karen Joyce
• Suhina Kapoor, DMD
• Mary Elizabeth Kelleher, LICSW
• Alice Anderson Kenney

• Addiction (Substance Use Disorder) Counselor in South Boston, MA
• Providers in South Boston, MA by specialty
• Addiction (Substance Use Disorder) Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.