Active NPI
Jessica Marie Laviolette, LMHC
- Mental Health Counselor
- West Brookfield, MA
National Provider Identifier
1487008173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 11009
- Practice address
- 62 Ware St
West Brookfield, MA 01585-3136 - Phone
- (508) 867-4451
- Fax
- (508) 867-3555
- NPI assigned
- Apr 19, 2016
- Sex
- Female
- Sole proprietor
- No
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 | 11009 | MA | Primary |
Addresses
Primary practice location
62 Ware St
West Brookfield, MA 01585-3136
Mailing address
62 Ware St
West Brookfield, MA 01585-3136
Phone (508) 867-4451
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11009 | Other | MA | LICENSE OF MENTAL HEALTH COUNSELING (LMHC) |
Other names 1
- Jessica Marie Willis
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 |
|---|---|---|---|
| 11009 | MA | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Bay Mental Health Center, Inc. | Past | Accepting new patients | |
| West Brookfield Counseling Center Inc | Mental Health | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Brockton, MA
- NPI 1023096864
-
- Mental Health Counselor
- West Brookfield, MA
- NPI 1861801813
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1461024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652659200000",
"number": "1487008173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "62 WARE ST",
"city": "WEST BROOKFIELD",
"state": "MA",
"postal_code": "015853136",
"telephone_number": "508-867-4451",
"fax_number": "508-867-3555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "62 WARE ST",
"city": "WEST BROOKFIELD",
"state": "MA",
"postal_code": "015853136",
"telephone_number": "508-867-4451",
"fax_number": "508-867-3555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAVIOLETTE",
"first_name": "JESSICA",
"middle_name": "MARIE",
"credential": "LMHC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-04-19",
"last_updated": "2022-05-16",
"certification_date": "2022-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MA",
"license": "11009",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE OF MENTAL HEALTH COUNSELING (LMHC)",
"identifier": "11009",
"state": "MA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JESSICA",
"last_name": "WILLIS",
"middle_name": "MARIE",
"credential": "LMHC",
"code": "1",
"type": "Former Name"
}
]
}Other providers in West Brookfield, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.