Amelia Fazackerley, MT-BC, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LMHC10002923 Issued in MA

Practice address

670 W Boylston St
Worcester, MA 01606-2092

Phone

(508) 853-2300

NPI assigned

Nov 16, 2022

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Northeast Health Services, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Taunton, MA
  • NPI 1225067481
  Medicare reassignment NPD
• Mental Health Specialty Group PA

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  MA

  Medicare reassignment NPD
• Quinsigamond Community College

  • Dental Clinic/Center
  • Worcester, MA
  • NPI 1245439397
  NPD (past)

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

{
    "created_epoch": "1668556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754352000000",
    "number": "1790494920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 KING PHILIP RD APT 1",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016062188",
            "telephone_number": "404-368-8528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 W BOYLSTON ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016062092",
            "telephone_number": "508-853-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAZACKERLEY",
        "first_name": "AMELIA",
        "credential": "MT-BC, LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-16",
        "last_updated": "2025-08-05",
        "certification_date": "2025-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "LMHC10002923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Faulkner, M.A., BCBA, LABA
• Misha-Michelle M Faustina, MD
• Isabel Fay, RD
• Liannne Fay, RN
• Madeleine R Fay, MD
• Hillary Rae Fazio, FNP-C
• Naome Mae Fearing, MSW
• Joanna Fearn Jalbert, LICSW
• Cindy Febus, BACHELOR
• Frank P Fechner, M.D.

• Mental Health Counselor in Worcester, MA
• Providers in Worcester, 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 5, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.