Active NPI
Jean Thomas, LMHC
- Mental Health Counselor
- Watertown, MA
National Provider Identifier
1790264968
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 12067
- Practice address
- 173 Mount Auburn St
Watertown, MA 02472-4005 - Phone
- (781) 454-8562
- NPI assigned
- Aug 8, 2018
- Last updated
- Sep 21, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Mental Health Counselor | 101YM0800X | 12067 | MA | Primary |
Addresses
Primary practice location
173 Mount Auburn St
Watertown, MA 02472-4005
Mailing address
173 Mount Auburn St
Watertown, MA 02472-4005
Phone (781) 454-8562
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 8, 2026 through May 8, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12067 | MA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663718400000",
"number": "1790264968",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "173 MOUNT AUBURN ST",
"city": "WATERTOWN",
"state": "MA",
"postal_code": "024724005",
"telephone_number": "781-454-8562"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "173 MOUNT AUBURN ST",
"city": "WATERTOWN",
"state": "MA",
"postal_code": "024724005",
"telephone_number": "781-454-8562"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMAS",
"first_name": "JEAN",
"credential": "LMHC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-08-08",
"last_updated": "2022-09-21",
"certification_date": "2022-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MA",
"license": "12067",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Watertown, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; 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.