Active NPI
Kendrick Maurice Ellison Jr.
- Mental Health Counselor
- Boston, MA
National Provider Identifier
1407225345
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- S11267675
- Practice address
- 714 Blue Hill Ave Apt 3
Boston, MA 02121-3239 - Phone
- (617) 637-0434
- NPI assigned
- Sep 22, 2015
- 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 | S11267675 | MA | Primary |
Addresses
Primary practice location
714 Blue Hill Ave Apt 3
Boston, MA 02121-3239
Mailing address
714 Blue Hill Ave Apt 3
Boston, MA 02121-3239
Phone (617) 637-0434
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S11267675 | MA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442880000000",
"number": "1407225345",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "714 BLUE HILL AVE APT 3",
"city": "BOSTON",
"state": "MA",
"postal_code": "021213239",
"telephone_number": "617-637-0434"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "714 BLUE HILL AVE APT 3",
"city": "BOSTON",
"state": "MA",
"postal_code": "021213239",
"telephone_number": "617-637-0434"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLISON",
"first_name": "KENDRICK",
"middle_name": "MAURICE",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-09-22",
"last_updated": "2015-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MA",
"license": "S11267675",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.