Jacqueline Kotoriy

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

70 Everett Ave Ste 515
Chelsea, MA 02150-2363

Phone

(617) 466-6650

NPI assigned

May 5, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

SB Transitional Sub LLCGroup PAC ID 7911315379, 70 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• SB Transitional Sub, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Brockton, MA
  • NPI 1962091173
  Medicare reassignment Care Compare group NPD
• South Bay Mental Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Brockton, MA
  • NPI 1023096864
  NPD

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

{
    "created_epoch": "1683244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683244800000",
    "number": "1699464537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 EVERETT AVE STE 515",
            "city": "CHELSEA",
            "state": "MA",
            "postal_code": "021502363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 EVERETT AVE STE 515",
            "city": "CHELSEA",
            "state": "MA",
            "postal_code": "021502363",
            "telephone_number": "617-466-6650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTORIY",
        "first_name": "JACQUELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-05",
        "last_updated": "2023-05-05",
        "certification_date": "2023-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Genia Ann Kluba, MSW
• Eric Knudsen
• Grace Sayomi Koah
• Xue-Jun (June) Kong, M.D.
• Angela Melissa Koontz
• Sarah Kotyra, MS, CCLS, DS
• Isabel Josefina Kovacs
• Philip B. Kraft, M. D.
• Herbert Fried Krohn, MD
• Nataly Kruh Elendt, MA, LMHC

• Mental Health Counselor in Chelsea, MA
• Providers in Chelsea, 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 May 5, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.