NPIMap

Organization Active NPI

Kintsugi Psychotherapy

  • Mental Health Counselor
  • Yarmouth Port, MA
National Provider Identifier
1508631839
Registry record updated Nov 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
KINTSUGI PSYCHOTHERAPY
Practice address
411 Route 6a BLDG 2
Yarmouth Port, MA 02675-1843
Phone
(508) 221-1224
NPI assigned
Nov 16, 2023
Last updated
Nov 16, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Angela Mallowes, LMHCNPI 1740895523
Title
Owner
Phone
(508) 221-1224

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU Primary

Addresses

Primary practice location

411 Route 6a BLDG 2
Yarmouth Port, MA 02675-1843

Mailing address

194 Main St
Brewster, MA 02631-1037
Phone (508) 221-1224

National Provider Directory

National Provider Directory

Locations

411 Route 6A
Bldg 2
Yarmouth Port, MA 02675
Phone (508) 221-1224

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1700092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700092800000",
    "number": "1508631839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "194 MAIN ST",
            "city": "BREWSTER",
            "state": "MA",
            "postal_code": "026311037",
            "telephone_number": "508-221-1224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 ROUTE 6A BLDG 2",
            "city": "YARMOUTH PORT",
            "state": "MA",
            "postal_code": "026751843",
            "telephone_number": "508-221-1224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINTSUGI PSYCHOTHERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-16",
        "last_updated": "2023-11-16",
        "certification_date": "2023-11-16",
        "status": "A",
        "authorized_official_last_name": "MALLOWES",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "508-221-1224",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yarmouth Port, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2023; 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.