Gabrielle Chudnow, MA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

111 Edgartown Rd
Vineyard Haven, MA 02568-5699

Phone

(508) 684-8620

NPI assigned

Jun 9, 2020

Last updated

Aug 11, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jun 26, 2024 through Jun 26, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rewilding Wellness LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Vineyard Haven, MA
  • NPI 1447979828
  NPD Authorized official

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

{
    "created_epoch": "1591660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597104000000",
    "number": "1669097325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 STATE RD # 313",
            "city": "VINEYARD HAVEN",
            "state": "MA",
            "postal_code": "025685695",
            "telephone_number": "508-684-8620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 EDGARTOWN RD",
            "city": "VINEYARD HAVEN",
            "state": "MA",
            "postal_code": "025685699",
            "telephone_number": "508-684-8620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHUDNOW",
        "first_name": "GABRIELLE",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-09",
        "last_updated": "2020-08-11",
        "certification_date": "2020-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1669097325",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gchudnow@mvcommunityservices.org",
            "affiliation": "N",
            "address_1": "111 Edgartown Rd",
            "city": "Vineyard Haven",
            "state": "MA",
            "country_code": "US",
            "postal_code": "025685699",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Cecilia Brennan
• Helene Yvonne Brown, LICSW
• Olivia Benoit Law Butler
• Jessica Yates Campbell, MSW
• Nancy Canha, B.A.
• Jackie Clason
• Alice Cook, MSW
• Lisa Cottrell, BA
• Caline Coutts, OTR/L
• Hallie Rose D'Angelo, MSW

• Mental Health Counselor in Vineyard Haven, MA
• Providers in Vineyard Haven, MA by specialty
• Mental Health Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2020; 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.

Verify at the official NPI Registry.