Organization Active NPI

M.O. L.I.F.E., Inc.

  • Mental Health Counselor
  • Fairhaven, MA
National Provider Identifier
1801487632
Registry record updated Feb 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
M.O. L.I.F.E., INC.
Practice address
4 Lambeth Park Dr
Fairhaven, MA 02719-4734
Phone
(508) 992-5978
NPI assigned
Feb 3, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2021

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

Authorized official

Name
Ivan BritoNPI 1528816519
Title
Coo
Phone
(774) 263-8897

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

4 Lambeth Park Dr
Fairhaven, MA 02719-4734

Mailing address

4 Lambeth Park Dr
Fairhaven, MA 02719-4734
Phone (508) 992-5978

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230120000970 MA Part B Supplier - Clinic/Group Practice 9234500760 Receives reassigned benefits from 2 practitioners
Practice locations: Fairhaven, MA

National Provider Directory

National Provider Directory

Locations

4 Lambeth Park Dr
Fairhaven, MA 02719
Phone (508) 992-5978

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1612310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612310400000",
    "number": "1801487632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 LAMBETH PARK DR",
            "city": "FAIRHAVEN",
            "state": "MA",
            "postal_code": "027194734",
            "telephone_number": "508-992-5978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 LAMBETH PARK DR",
            "city": "FAIRHAVEN",
            "state": "MA",
            "postal_code": "027194734",
            "telephone_number": "508-992-5978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M.O. L.I.F.E., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-03",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-02",
        "status": "A",
        "authorized_official_last_name": "BRITO",
        "authorized_official_first_name": "IVAN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "774-263-8897"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairhaven, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.