Individual provider Active NPI

Paul Dever Fitzgerald

  • Mental Health Counselor
  • Canton, MA
National Provider Identifier
1811316904
Registry record updated Mar 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
10000016 Issued in MA
Practice address
900 Washington St
Canton, MA 02021-2574
Phone
(817) 820-5050
NPI assigned
Apr 16, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 10000016 MA Primary

Addresses

Primary practice location

900 Washington St
Canton, MA 02021-2574

Mailing address

900 Washington St
Canton, MA 02021-2574
Phone (781) 821-5050

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240617000780 MA Practitioner - Mental Health Counselor 6709329907 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10000016MAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Health Services, LLC CurrentSince Jun 1, 2024 Accepting new patients

Locations

225 Foxborough Blvd
Ste 201
Foxborough, MA 02035
Phone (508) 901-4685

30 Taunton Grn
Ste 5
Taunton, MA 02780
Phone (508) 545-7400

Interoperability endpoints

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

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.

NPI Registry JSON

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

{
    "created_epoch": "1397606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742428800000",
    "number": "1811316904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 WASHINGTON ST",
            "city": "CANTON",
            "state": "MA",
            "postal_code": "020212574",
            "telephone_number": "781-821-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 WASHINGTON ST",
            "city": "CANTON",
            "state": "MA",
            "postal_code": "020212574",
            "telephone_number": "817-820-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZGERALD",
        "first_name": "PAUL",
        "middle_name": "DEVER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-16",
        "last_updated": "2025-03-20",
        "certification_date": "2025-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "10000016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, MA

Sources for this page

Verify at the official NPI Registry.