Jeff Citro, M.A., M.DIV. – Professional Counselor

Key facts

NPI: 1568716918
Entity type: Individual (NPI type 1)
Primary specialty: Professional Counselor 101YP2500X
License: LPC.0015804 (CO)
Practice address: 1115 W Chestnut St
Brockton, MA 02301-7501
Phone: (508) 580-4691
NPI assigned: Nov 7, 2012
Sex: Male
Sole proprietor: Yes

Organizations & group practices 3

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.

Heart of Boardwalk Inc Adult Mental Health Clinic/Center · Denver, CO · NPI 1134129034

Medicare reassignment NPD CO
Neurofeedback Colorado Springs, Inc. Clinical Psychologist · Colorado Springs, CO · NPI 1972048098

NPD MENTAL HEALTH
Recoveryworks Clinical Social Worker · Lakewood, CO · NPI 1528899416

NPD PROFESSIONAL

Medicare participation

Medicare fee-for-service enrollment: Enrolled in CO
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20250124002805	CO	Practitioner - Mental Health Counselor	0345779054	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Master of Arts

State licenses

License	State	Type	Specialty
LPC.0015804	CO	MD	Professional Counselor

Practice roles

Organization	Specialty	Status	New patients
Heart of Boardwalk Inc		Current since Jan 1, 2025	Accepting new patients
Neurofeedback Colorado Springs, Inc.	Mental Health	Current since Oct 10, 2021	Accepting new patients
Recoveryworks	Professional	Current	Accepting new patients

Locations

1283 Kelly Johnson Blvd
Colorado Springs, CO 80920
Phone (719) 413-6776

709 E 12th Ave
Denver, CO 80203
Phone (303) 830-8805

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Mental Health Counselor	101YM0800X
Professional Counselor	101YP2500X	LPC.0015804	CO	Yes

Addresses

Primary practice location

1115 W Chestnut St
Brockton, MA 02301-7501

Mailing address

1283 Kelly Johnson Blvd
Colorado Springs, CO 80920-3925
Phone (719) 413-6776

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 6, 2021.

{
    "created_epoch": "1352246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633478400000",
    "number": "1568716918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1283 KELLY JOHNSON BLVD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809203925",
            "telephone_number": "719-413-6776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 W CHESTNUT ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023017501",
            "telephone_number": "508-580-4691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CITRO",
        "first_name": "JEFF",
        "name_prefix": "Mr.",
        "credential": "M.A., M.DIV.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-11-07",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CO",
            "license": "LPC.0015804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

All providers in Brockton, MA · Professional Counselor in Massachusetts

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 6, 2021. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.