Active NPI
Jessica Monin Burgos, BA
- Mental Health Counselor
- Worcester, MA
National Provider Identifier
1508454570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 11 Sycamore St # 1
Worcester, MA 01608-2213 - Phone
- (508) 933-4572
- NPI assigned
- Jan 6, 2021
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MA | Primary |
Addresses
Primary practice location
11 Sycamore St # 1
Worcester, MA 01608-2213
Mailing address
120 Burncoat St # 1
Worcester, MA 01605-1333
Phone (508) 933-4572
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| FD8ED938-F469-49E8-9 | Medicaid | MA |
Other names 1
- Jessica Monin Luciano
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | WORCESTER | Health Information Exchange (HIE) |
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
- Credentials
- Bachelor of Arts
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609891200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609891200000",
"number": "1508454570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 BURNCOAT ST # 1",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016051333",
"telephone_number": "508-933-4572"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 SYCAMORE ST # 1",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016082213",
"telephone_number": "508-933-4572"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURGOS",
"first_name": "JESSICA",
"middle_name": "MONIN",
"credential": "BA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-01-06",
"last_updated": "2021-01-06",
"certification_date": "2020-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "FD8ED938-F469-49E8-9",
"state": "MA"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "WORCESTER",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "WORCESTER",
"address_1": "11 Sycamore St # 1",
"city": "Worcester",
"state": "MA",
"country_code": "US",
"postal_code": "016082213",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "JESSICA",
"last_name": "LUCIANO",
"middle_name": "MONIN",
"credential": "JESSICA M.LUCIANO",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.