Active NPI
Mathew John Madonna, PSYA.D., LMHC
- Mental Health Counselor
- Athol, MA
National Provider Identifier
1467058800
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 9171
- Practice address
- 59 Adams Rd
Athol, MA 01331-9751 - Phone
- (774) 641-6228
- NPI assigned
- Dec 10, 2020
- 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 | 9171 | MA | Primary |
Addresses
Primary practice location
59 Adams Rd
Athol, MA 01331-9751
Mailing address
59 Adams Rd
Athol, MA 01331-9751
Phone (774) 641-6228
Other practice location 1
242 Green Street
Heywood Healthcare
Gardner, MA 01440
Phone (978) 632-3420 ext. 6377
Other practice location 2
160 Elm St Ofc
Greenfield, MA 01301-2211
Phone (413) 774-4014 ext. 2117
Other practice location 3
469 Chandler St
Worcester, MA 01602-2529
Phone (508) 757-7430
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 |
|---|---|---|---|
| 9171 | MA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607558400000",
"number": "1467058800",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "59 ADAMS RD",
"city": "ATHOL",
"state": "MA",
"postal_code": "013319751",
"telephone_number": "774-641-6228"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "59 ADAMS RD",
"city": "ATHOL",
"state": "MA",
"postal_code": "013319751",
"telephone_number": "774-641-6228"
}
],
"practiceLocations": [
{
"address_1": "242 Green Street",
"address_2": "Heywood Healthcare",
"address_purpose": "LOCATION",
"city": "Gardner",
"state": "MA",
"postal_code": "01440",
"country_code": "US",
"telephone_number": "978-632-3420 x6377",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "160 Elm St Ofc",
"address_purpose": "LOCATION",
"city": "Greenfield",
"state": "MA",
"postal_code": "013012211",
"country_code": "US",
"telephone_number": "413-774-4014 x2117",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "469 Chandler St",
"address_purpose": "LOCATION",
"city": "Worcester",
"state": "MA",
"postal_code": "016022529",
"country_code": "US",
"telephone_number": "508-757-7430",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MADONNA",
"first_name": "MATHEW",
"middle_name": "JOHN",
"credential": "PSYA.D., LMHC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-12-10",
"last_updated": "2020-12-10",
"certification_date": "2020-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MA",
"license": "9171",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Athol, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.