Gina M. Conner, MA, LAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

37AC00363800 Issued in NJ

Practice address

175 Fairfield Ave Ste 1C
West Caldwell, NJ 07006-6415

Phone

(973) 865-4454

NPI assigned

Mar 22, 2021

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

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Be Well Psychotherapy LLCGroup PAC ID 0042640807, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

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.

• Be Well Psychotherapy, LLC

  • Mental Health Counselor
  • West Caldwell, NJ
  • NPI 1730723438
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1616371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1356927263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 FAIRFIELD AVE STE 1C",
            "city": "WEST CALDWELL",
            "state": "NJ",
            "postal_code": "070066415",
            "telephone_number": "973-865-4454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 FAIRFIELD AVE STE 1C",
            "city": "WEST CALDWELL",
            "state": "NJ",
            "postal_code": "070066415",
            "telephone_number": "973-865-4454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNER",
        "first_name": "GINA",
        "middle_name": "M.",
        "credential": "MA, LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-22",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NJ",
            "license": "37AC00363800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Collaborative Autism Services, LLC
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• Complete Care at West Caldwell LLC
• Concierge Breast Imaging & Radiological Services, P.C.
• Corey Condon, OTR
• Sally Ann Corbo, APRN
• Counseling Center at Clark, LLC
• Michelle Cox, LCSW
• Hannah Cozzolino, DDS
• Franco Crincoli, PTA

• Mental Health Counselor in West Caldwell, NJ
• Providers in West Caldwell, NJ by specialty
• Mental Health Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.