Active NPI
Keith Willette
- Counselor
- Worcester, MA
National Provider Identifier
1619234101
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 255 Park Ave
Worcester, MA 01609-1953 - Phone
- (508) 799-0688
- NPI assigned
- Apr 20, 2012
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | Primary |
Addresses
Primary practice location
255 Park Ave
Worcester, MA 01609-1953
Mailing address
255 Park Ave
Worcester, MA 01609-1953
Phone (508) 799-0688
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 11, 2024 through Nov 11, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1334880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1334880000000",
"number": "1619234101",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "255 PARK AVE",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016091953",
"telephone_number": "508-799-0688"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "255 PARK AVE",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016091953",
"telephone_number": "508-799-0688"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLETTE",
"first_name": "KEITH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-04-20",
"last_updated": "2012-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Apr 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.