North Charles Mental Health Research & Training Foundation, Inc

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

NORTH CHARLES MENTAL HEALTH RESEARCH & TRAINING FOUNDATION, INC

Practice address

54 Washburn Ave
Cambridge, MA 02140-1128

Phone

(617) 864-0941

Fax

(617) 876-9760

NPI assigned

Nov 9, 2006

Last updated

Jan 24, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Gary R Houle

Title

Ceo

Phone

(617) 864-0941

Specialties & licenses 15

Addresses

Other identifiers 11

Other names 1

• NORTH CHARLES, INC. Other name

Medicare fee-for-service enrollment

Enrolled in MA2 enrollments

Opioid treatment program

Medicare-enrolled since Jan 1, 2020

Enrollment records 2

Tax ID family

North Charles Mental He2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Dana Ellsmore

  • Addiction (Substance Use Disorder) Counselor
  • Somerville, MA
  • NPI 1013283134
  NPD tax ID

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Cambridge Psychiatric Services, Inc

  • Addiction Psychiatry Physician
  • Cambridge, MA
  • NPI 1851055784

  Member Of

  NPD member

Locations

Practitioners 44

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennifer Brill, LICSW

  • Clinical Social Worker
  • Cambridge, MA
  • NPI 1285715276
  Medicare reassignment Care Compare group NPD
• Robert Gerard Dello Russo, PH.D., LADC I

  • Addiction (Substance Use Disorder) Psychologist
  • Boston, MA
  • NPI 1609867670
  Medicare reassignment Care Compare group NPD
• Amy L Armstrong, LICSW

  • Mental Health Counselor
  • Brookline, MA
  • NPI 1609961085
  Medicare reassignment NPD
• Julia Ruth Calnan, LICSW

  • Clinical Social Worker
  • Boston, MA
  • NPI 1649418898

  Addiction (Substance Use Disorder)

  Medicare reassignment NPD
• Margaret Latawiec

  • Social Worker
  • Boston, MA
  • NPI 1992876361
  Medicare reassignment NPD
• Smita Patel, MD

  • Psychiatry Physician
  • Stoneham, MA
  • NPI 1619913894
  Medicare reassignment NPD
• Jessica Tye Zieky, LICSW

  • Clinical Social Worker
  • Needham, MA
  • NPI 1679723639
  Medicare reassignment NPD
• Mark Joseph Albanese, M.D.

  • Addiction Psychiatry Physician
  • Somerville, MA
  • NPI 1366475675
  NPD
• Elizabeth A Davis, MD

  • Psychiatry Physician
  • Boston, MA
  • NPI 1306870480
  NPD
• Halle Davis, LICSW

  • Social Worker
  • Quincy, MA
  • NPI 1861113011
  NPD
• Chloe Deloughery

  • Addiction (Substance Use Disorder) Counselor
  • Cambridge, MA
  • NPI 1457965907
  NPD
• Michelle Harra Goldberg

  • Addiction (Substance Use Disorder) Counselor
  • Cambridge, MA
  • NPI 1275181208
  NPD

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579824000000",
    "number": "1356411862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 WASHBURN AVE",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021401128",
            "telephone_number": "617-864-0941",
            "fax_number": "617-876-9760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 WASHBURN AVE",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021401128",
            "telephone_number": "617-864-0941",
            "fax_number": "617-876-9760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH CHARLES MENTAL HEALTH RESEARCH & TRAINING FOUNDATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2020-01-24",
        "certification_date": "2020-01-24",
        "status": "A",
        "authorized_official_last_name": "HOULE",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "617-864-0941",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "99420501",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306405",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "222301740",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "NHC222300091 42",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "NHC222300091 41",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1005250",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1303902",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "NHC222300091 40",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT LABOR OWCP",
            "identifier": "119333300",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1303929",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOSTON HEALTHNET",
            "identifier": "37052",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTH CHARLES, INC.",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "NORTH CHARLES, INC.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Psychologist in Cambridge, MA
• Providers in Cambridge, MA by specialty
• Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2020; 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.