Active NPI
Juan Carlos Goris, LICSW
- Mental Health Counselor
- Fitchburg, MA
National Provider Identifier
1649528860
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 123312
- Practice address
- 344 Main St
Fitchburg, MA 01420-8007 - Phone
- (978) 503-1700
- NPI assigned
- Aug 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 123312 | MA | Primary |
Addresses
Primary practice location
344 Main St
Fitchburg, MA 01420-8007
Mailing address
344 Main St
Fitchburg, MA 01420-8007
Phone (978) 503-1700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Apr 10, 2024 through Apr 10, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 123312 | MA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1345420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631664000000",
"number": "1649528860",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "344 MAIN ST",
"city": "FITCHBURG",
"state": "MA",
"postal_code": "014208007",
"telephone_number": "978-503-1700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "344 MAIN ST",
"city": "FITCHBURG",
"state": "MA",
"postal_code": "014208007",
"telephone_number": "978-503-1700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORIS",
"first_name": "JUAN CARLOS",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-08-20",
"last_updated": "2021-09-15",
"certification_date": "2021-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MA",
"license": "123312",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fitchburg, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.