Individual provider Active NPI

Marvel Larose

  • Foster Care Agency
  • Randolph, MA
National Provider Identifier
1407209620
Registry record updated Dec 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foster Care AgencyTaxonomy code 253J00000X
Practice address
217 Chestnut St
Randolph, MA 02368-2407
Phone
(857) 991-0110
NPI assigned
Jul 22, 2016
Last updated
Dec 5, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 5, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X RN2292446 MA
Foster Care Agency 253J00000X Primary

Addresses

Primary practice location

217 Chestnut St
Randolph, MA 02368-2407

Mailing address

101 S Main St
Randolph, MA 02368-4896
Phone (857) 991-0110

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260224003356 MA Practitioner - Nurse Practitioner 7517390826 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Supportive Behavioral Care of Ma LLCGroup PAC ID 8628346731, 103 clinicians

Practice addresses (Care Compare)

44 School St
RM 325
Boston, MA 02108-4209
Phone (718) 298-4375

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN2292446MAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Caridad Behavioral Health & Counseling, LLC Psychiatric/Mental Health CurrentSince Dec 7, 2025 Accepting new patients
First-Class Behavioral & Counseling Services Psychiatric/Mental Health CurrentSince Feb 17, 2026 Accepting new patients
Caridad Independent Living LLC Foster Care Agency CurrentSince Aug 3, 2016 Accepting new patients

Locations

1017 Turnpike St
#32A
Canton, MA 02021
Phone (781) 236-7343

1017 Turnpike St
Ste 32A
Canton, MA 02021
Phone (781) 236-7343

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Caridad Independent LivingRandolph, MA, CCN 227748 Home health agency 5% Or Greater Direct Ownership Interest (96%)
Corporate Director (50%)
W-2 Managing Employee (100%)
Aug 3, 2016
Aug 3, 2016
Aug 2, 2016

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1469145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764892800000",
    "number": "1407209620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 S MAIN ST",
            "city": "RANDOLPH",
            "state": "MA",
            "postal_code": "023684896",
            "telephone_number": "857-991-0110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 CHESTNUT ST",
            "city": "RANDOLPH",
            "state": "MA",
            "postal_code": "023682407",
            "telephone_number": "857-991-0110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAROSE",
        "first_name": "MARVEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-07-22",
        "last_updated": "2025-12-05",
        "certification_date": "2025-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MA",
            "license": "RN2292446",
            "primary": false
        },
        {
            "code": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Randolph, MA

Sources for this page

Verify at the official NPI Registry.