Active NPI
Matthew Taylor Miracle, BA
- Mental Health Counselor
- North Grafton, MA
National Provider Identifier
1689921397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 12165
- Practice address
- 80 Worcester St
North Grafton, MA 01536-1041 - Phone
- (774) 293-1116
- Fax
- (774) 389-0308
- NPI assigned
- Aug 13, 2012
- 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 | 12165 | MA | Primary |
Addresses
Primary practice location
80 Worcester St
North Grafton, MA 01536-1041
Mailing address
76 Church St Ste 301
Whitinsville, MA 01588-1464
Phone (508) 234-4181
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
- Bachelor of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12165 | MA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Marisa Molinaro, LMHC, LLC | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Counselor
- North Grafton, MA
- NPI 1295356335
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653264000000",
"number": "1689921397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "76 CHURCH ST STE 301",
"city": "WHITINSVILLE",
"state": "MA",
"postal_code": "015881464",
"telephone_number": "508-234-4181",
"fax_number": "508-234-3944"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "80 WORCESTER ST",
"city": "NORTH GRAFTON",
"state": "MA",
"postal_code": "015361041",
"telephone_number": "774-293-1116",
"fax_number": "774-389-0308"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRACLE",
"first_name": "MATTHEW",
"middle_name": "TAYLOR",
"name_prefix": "Mr.",
"credential": "BA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-13",
"last_updated": "2022-05-23",
"certification_date": "2022-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MA",
"license": "12165",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Grafton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 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.