Active NPI
Gabriel Glass, 172V00000X
- Mental Health Counselor
- Peabody, MA
National Provider Identifier
1619629441
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 172V00000X
- Practice address
- 9 Centennial Dr Unit 101
Peabody, MA 01960-7940 - Phone
- (617) 790-4800
- Fax
- (978) 531-0965
- NPI assigned
- Jan 23, 2022
- Sex
- Male
- Sole proprietor
- No
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 | 172V00000X | MA | Primary |
Addresses
Primary practice location
9 Centennial Dr Unit 101
Peabody, MA 01960-7940
Mailing address
9 Centennial Dr Unit 101
Peabody, MA 01960-7940
Phone (617) 790-4800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 172V00000X | Other | MA | MENTOR/COUNSELOR |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 172V00000X | MA | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642896000000",
"number": "1619629441",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 CENTENNIAL DR UNIT 101",
"city": "PEABODY",
"state": "MA",
"postal_code": "019607940",
"telephone_number": "617-790-4800",
"fax_number": "978-531-0965"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9 CENTENNIAL DR UNIT 101",
"city": "PEABODY",
"state": "MA",
"postal_code": "019607940",
"telephone_number": "617-790-4800",
"fax_number": "978-531-0965"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLASS",
"first_name": "GABRIEL",
"credential": "172V00000X",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-01-23",
"last_updated": "2022-01-23",
"certification_date": "2022-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MA",
"license": "172V00000X",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MENTOR/COUNSELOR",
"identifier": "172V00000X",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Peabody, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.