NPIMap

Organization Active NPI

Massachusetts General Hospital Revere Healthcare Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Revere, MA
National Provider Identifier
1871715151
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
111447 Issued in MA
Legal business name
MASSACHUSETTS GENERAL HOSPITAL REVERE HEALTHCARE CENTER
Practice address
300 Ocean Ave
Revere, MA 02151-3675
Phone
(617) 510-9458
Fax
(781) 485-6119
NPI assigned
May 3, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Marykate P Shorter, LICSWNPI 1639360605
Title
Social Worker
Phone
(781) 485-6112

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 Clinic/Center (Including Community Mental Health Center) 261QM0801X 111447 MA Primary

Addresses

Primary practice location

300 Ocean Ave
Revere, MA 02151-3675

Mailing address

416 Marlborough St
#708
Boston, MA 02115-1544
Phone (617) 510-9458

National Provider Directory

National Provider Directory
Tax ID family
Psychiatry Consult Serv13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871715151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 MARLBOROUGH ST",
            "address_2": "#708",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021151544",
            "telephone_number": "617-510-9458",
            "fax_number": "781-485-6119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 OCEAN AVE",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021513675",
            "telephone_number": "617-510-9458",
            "fax_number": "781-485-6119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASSACHUSETTS GENERAL HOSPITAL REVERE HEALTHCARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHORTER",
        "authorized_official_first_name": "MARYKATE",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "SOCIAL WORKER",
        "authorized_official_telephone_number": "781-485-6112",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MA",
            "license": "111447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Revere, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.