NPIMap

Individual provider Active NPI

Keith Gilliam, LMHC

  • Mental Health Counselor
  • Dorchester, MA
National Provider Identifier
1598058588
Registry record updated May 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
7069 Issued in MA
Practice address
90 Cushing Ave
Dorchester, MA 02125-2028
Phone
(617) 436-8600
Fax
(617) 282-2912
NPI assigned
May 24, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 7069 MA Primary

Addresses

Primary practice location

90 Cushing Ave
Dorchester, MA 02125-2028

Mailing address

49 S Huntington Ave
Apt 204
Jamaica Plain, MA 02130-4732

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

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary'S Center for Women and Children Mental Health Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1306195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306195200000",
    "number": "1598058588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 S HUNTINGTON AVE",
            "address_2": "APT 204",
            "city": "JAMAICA PLAIN",
            "state": "MA",
            "postal_code": "021304732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 CUSHING AVE",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021252028",
            "telephone_number": "617-436-8600",
            "fax_number": "617-282-2912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLIAM",
        "first_name": "KEITH",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-24",
        "last_updated": "2011-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "7069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dorchester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2011; 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.