Liana Kim Van de Water

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

100 George P Hassett Dr
Medford, MA 02155-3258

Phone

(781) 393-4828

NPI assigned

Jun 25, 2019

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 MA

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, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lynn Community Health, Inc.Group PAC ID 0042217507, 95 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Lynn Community Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Lynn, MA
  • NPI 1013997691
  Medicare reassignment Care Compare group NPD
• Hri Clinics Inc

  • Community/Behavioral Health Agency
  • Norwell, MA
  • NPI 1922123199
  NPD (past)

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

{
    "created_epoch": "1561420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561420800000",
    "number": "1437710084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 GEORGE P HASSETT DR",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021553258",
            "telephone_number": "781-393-4828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 GEORGE P HASSETT DR",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021553258",
            "telephone_number": "781-393-4828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DE WATER",
        "first_name": "LIANA",
        "middle_name": "KIM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-25",
        "last_updated": "2019-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Union Square Physical Therapy LLC.
• Antonia M Urdi
• Urgent Care of Medford, LLC
• Chantal Valentin, RN
• David Valenza
• Srilekha Mahi Vangala
• Amy Lee Velez
• Jeff Velez, M.D.
• Therese Venedikian, DMD
• Michelle Vidal, LICSW

• Counselor in Medford, MA
• Providers in Medford, MA by specialty
• Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2019; 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.