NPIMap

Organization Active NPI

Old Colony Young Men's Christian Association, Inc.

Doing business as Old Colony Y Comprehensive Counseling

  • Clinical Psychologist
  • Brockton, MA
National Provider Identifier
1366506677
Registry record updated Mar 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
4796 Issued in MA
Legal business name
OLD COLONY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.
Doing business as
Old Colony Y Comprehensive Counseling
Practice address
104 Torrey Street
Brockton, MA 02301-4855
Phone
(508) 427-4383
Fax
(508) 584-4328
NPI assigned
Dec 21, 2006
Last updated
Mar 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2024

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

Authorized official

Name
Ms. Donna J Desmond, CPA, MBA
Title
Evp, Cfo
Phone
(508) 897-1230

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 4796 MA Primary
Clinical Social Worker 1041C0700X 4796 MA
Child & Adolescent Psychiatry Physician 2084P0804X 4796 MA
Health Educator 174H00000X

Addresses

Primary practice location

104 Torrey Street
Brockton, MA 02301-4855

Mailing address

104 Torrey Street
Brockton, MA 02301-4855
Phone (508) 427-4383

Other identifiers 1

IdentifierTypeStateIssuer
1319736MedicaidMA

Other names 1

  • Old Colony Y Comprehensive Counseling Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091118000040 MA Part B Supplier - Clinic/Group Practice 7416991393 Receives reassigned benefits from 2 practitioners
Practice locations: Brockton, MA

National Provider Directory

National Provider Directory

Locations

104 Torrey St
Brockton, MA 02301
Phone (508) 274-4383

15 Bolton Pl
#A
Brockton, MA 02301
Phone (508) 427-4383

891 Montello St
Brockton, MA 02301
Phone (508) 427-4383

891 Montello St
Fl 1
Brockton, MA 02301

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 32

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.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709251200000",
    "number": "1366506677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 TORREY STREET",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023014855",
            "telephone_number": "508-427-4383",
            "fax_number": "508-584-4328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 TORREY STREET",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023014855",
            "telephone_number": "508-427-4383",
            "fax_number": "508-584-4328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD COLONY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2024-03-01",
        "status": "A",
        "authorized_official_last_name": "DESMOND",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EVP, CFO",
        "authorized_official_telephone_number": "508-897-1230",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CPA, MBA"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "4796",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "4796",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MA",
            "license": "4796",
            "primary": false
        },
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1319736",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Old Colony Y Comprehensive Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brockton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; 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.