Individual provider Active NPI

Stephanie D. Tavarez, LMHC

  • Mental Health Counselor
  • Boston, MA
National Provider Identifier
1891046371
Registry record updated Dec 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
5000956 Issued in MA
Practice address
780 Albany St
Boston, MA 02118-2755
Phone
(857) 654-1000
Fax
(857) 654-1100
NPI assigned
Sep 25, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2023

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 5000956 MA Primary

Addresses

Primary practice location

780 Albany St
Boston, MA 02118-2755

Mailing address

780 Albany St
Boston, MA 02118-2755
Phone (857) 654-1000

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
I20240105000624 MA Practitioner - Mental Health Counselor 0042661811 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1785 Columbus Ave
Suite 200
Roxbury, MA 02119-1041
Phone (857) 654-6610

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5000956MAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Boston Health Care for the Homeless Program, Inc. Current Accepting new patients
Boston Health Care for the Homeless Program, Inc. CurrentSince Jan 1, 2024 Accepting new patients
Boston Health Care for the Homeless Program, Inc. CurrentSince Jan 1, 2024 Accepting new patients

Locations

780 Albany St
Boston, MA 02118
Phone (857) 654-1000

780 Albany St
#2130
Boston, MA 02118

Organizations & group practices 3

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": "1348531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703116800000",
    "number": "1891046371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 ALBANY ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182755",
            "telephone_number": "857-654-1000",
            "fax_number": "857-654-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 ALBANY ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182755",
            "telephone_number": "857-654-1000",
            "fax_number": "857-654-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAVAREZ",
        "first_name": "STEPHANIE",
        "middle_name": "D.",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-25",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "5000956",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.