Malida Theodore

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

57 Oscar Ave
Brockton, MA 02302-1047

Phone

(617) 283-6211

NPI assigned

Aug 31, 2016

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Good Life Health Services Inc

  • Home Health Agency
  • Brockton, MA
  • NPI 1861997611
  NPD Authorized official
• Theodoss Multi Services and Investments LLC

  • Community/Behavioral Health Agency
  • Brockton, MA
  • NPI 1144050048
  NPD Authorized official
• Theodoss Multi Services Inc

  • Case Manager/Care Coordinator
  • Brockton, MA
  • NPI 1578491205

  Community Health Worker

  NPD Authorized official

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

{
    "created_epoch": "1472601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722816000000",
    "number": "1497201271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "623 CENTRE ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023023307",
            "telephone_number": "617-283-6211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 OSCAR AVE",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023021047",
            "telephone_number": "617-283-6211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEODORE",
        "first_name": "MALIDA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-31",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Wellness Journey Studio
• The Wholeness Center, LLC
• Shannon Thebado
• Samantha Lee Thebeault, M.S., CF-SLP
• Fabiola Theodore
• Marie-Noel Theodore, LCSW
• Cassandra Theodoris, NP
• Theodoss Multi Services and Investments LLC
• Theodoss Multi Services Inc
• Theraconnex LLC

• Community Health Worker in Brockton, MA
• Providers in Brockton, MA by specialty
• Community Health Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.