Active NPI
Mark Francis Theodore, MA, LSW
- Professional Counselor
- Fall River, MA
National Provider Identifier
1629131263
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 3024783
- Practice address
- 795 Middle St
Fall River, MA 02721-1733 - Phone
- (508) 674-5600
- Fax
- (508) 235-5009
- NPI assigned
- Dec 18, 2006
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 3024783 | MA | Primary |
Addresses
Primary practice location
795 Middle St
Fall River, MA 02721-1733
Mailing address
795 Middle St
Fall River, MA 02721-1733
Phone (508) 674-5600
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3024783 | MA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305072000000",
"number": "1629131263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "795 MIDDLE ST",
"city": "FALL RIVER",
"state": "MA",
"postal_code": "027211733",
"telephone_number": "508-674-5600",
"fax_number": "508-235-5009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "795 MIDDLE ST",
"city": "FALL RIVER",
"state": "MA",
"postal_code": "027211733",
"telephone_number": "508-674-5600",
"fax_number": "508-235-5009"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THEODORE",
"first_name": "MARK",
"middle_name": "FRANCIS",
"name_prefix": "Mr.",
"credential": "MA, LSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-18",
"last_updated": "2011-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MA",
"license": "3024783",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fall River, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 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.