Active NPI
Christopher John Medeiros, LMHC
- Mental Health Counselor
- Jamaica Plain, MA
National Provider Identifier
1407196512
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 1304
- Practice address
- 157 Green St
Jamaica Plain, MA 02130-2667 - Phone
- (617) 390-1454
- NPI assigned
- Feb 26, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 1304 | MA | Primary |
Addresses
Primary practice location
157 Green St
Jamaica Plain, MA 02130-2667
Mailing address
3305 Washington St
Apt 2
Jamaica Plain, MA 02130-2639
Phone (617) 620-0121
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Sep 17, 2024 through Sep 17, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1304 | MA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1361836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1361836800000",
"number": "1407196512",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3305 WASHINGTON ST",
"address_2": "APT 2",
"city": "JAMAICA PLAIN",
"state": "MA",
"postal_code": "021302639",
"telephone_number": "617-620-0121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "157 GREEN ST",
"city": "JAMAICA PLAIN",
"state": "MA",
"postal_code": "021302667",
"telephone_number": "617-390-1454"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDEIROS",
"first_name": "CHRISTOPHER",
"middle_name": "JOHN",
"credential": "LMHC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-02-26",
"last_updated": "2013-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MA",
"license": "1304",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jamaica Plain, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.