NPIMap

Organization Active NPI

Mental Health Matters Practice PLLC

Doing business as Ellie Mental Health

  • Clinical Social Worker
  • Cambridge, MA
National Provider Identifier
1356052641
Registry record updated Mar 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
MENTAL HEALTH MATTERS PRACTICE PLLC
Doing business as
Ellie Mental Health
Practice address
875 Massachusetts Ave Ste 4
Cambridge, MA 02139-3067
Phone
(617) 812-1697
Fax
(617) 812-1697
NPI assigned
Dec 8, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2023

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

Authorized official

Name
Mrs. Kayley Walsh, LICSW #119282NPI 1356859037
Title
Clinical Director
Phone
(781) 835-5733

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

875 Massachusetts Ave Ste 4
Cambridge, MA 02139-3067

Mailing address

875 Massachusetts Ave Ste 4
Cambridge, MA 02139-3067
Phone (513) 638-2323

Other names 1

  • Ellie Mental Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20211210002230 IL Part B Supplier - Clinic/Group Practice 0840680575 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Batavia, IL; St Charles, IL; Wheaton, IL
O20230504001716 MA Part B Supplier - Clinic/Group Practice 1456716067 Receives reassigned benefits from 3 practitioners
Practice locations: Cambridge, MA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

875 Massachusetts Ave
Ste 4
Cambridge, MA 02139
Phone (513) 638-2323

875 Massachusetts Ave
Ste 41
Cambridge, MA 02139
Phone (617) 497-2124

875 Massachusetts Ave
Ste 1
Cambridge, MA 02139

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1670457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678924800000",
    "number": "1356052641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 MASSACHUSETTS AVE STE 4",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021393067",
            "telephone_number": "513-638-2323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 MASSACHUSETTS AVE STE 4",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021393067",
            "telephone_number": "617-812-1697",
            "fax_number": "617-812-1697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTAL HEALTH MATTERS PRACTICE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-08",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A",
        "authorized_official_last_name": "WALSH",
        "authorized_official_first_name": "KAYLEY",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "781-835-5733",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LICSW #119282"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellie Mental Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ellie Mental Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cambridge, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.