Active NPI
Maryellen Newman
- Mental Health Counselor
- Randolph, MA
National Provider Identifier
1457614448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 111 Liberty St
Randolph, MA 02368-3727 - Phone
- (401) 368-9714
- NPI assigned
- Jun 25, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary | ||
| Addiction (Substance Use Disorder) Counselor | 101YA0400X |
Addresses
Primary practice location
111 Liberty St
Randolph, MA 02368-3727
Mailing address
111 Liberty St
Randolph, MA 02368-3727
Phone (401) 368-9714
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340582400000",
"number": "1457614448",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 LIBERTY ST",
"city": "RANDOLPH",
"state": "MA",
"postal_code": "023683727",
"telephone_number": "401-368-9714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 LIBERTY ST",
"city": "RANDOLPH",
"state": "MA",
"postal_code": "023683727",
"telephone_number": "401-368-9714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEWMAN",
"first_name": "MARYELLEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-06-25",
"last_updated": "2012-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Randolph, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2012; 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.