NPIMap

Organization Active NPI

Cornerstone Behavioral Health Inc.

  • Clinical Psychologist
  • Worcester, MA
National Provider Identifier
1902227275
Registry record updated Jan 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
3358 Issued in MA
Legal business name
CORNERSTONE BEHAVIORAL HEALTH INC.
Practice address
30 Sever St
Worcester, MA 01609-2194
Phone
(774) 253-1573
NPI assigned
Jan 3, 2014
Last updated
Jan 6, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2014

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

Authorized official

Name
Dr. Peter W Moran, PH.DNPI 1700809399
Title
Director
Phone
(774) 253-1573

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 7

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 7013 MA
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 7534 MA
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 6209 MA
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 3358 MA Primary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 7497 MA
Geriatric Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0805X 239917 MA
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X RN198309 MA

Addresses

Primary practice location

30 Sever St
Worcester, MA 01609-2194

Mailing address

30 Sever St
Worcester, MA 01609-2194

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150720000253 MA Part B Supplier - Clinic/Group Practice 9537472642 Receives reassigned benefits from 7 practitioners
Practice locations: Worcester, MA

National Provider Directory

National Provider Directory

Locations

45 Lyman St
Ste 11
Westborough, MA 01581
Phone (508) 791-3677

Practitioners & affiliated clinicians

Practitioners 11

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": "1388707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388966400000",
    "number": "1902227275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 SEVER ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016092194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 SEVER ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016092194",
            "telephone_number": "774-253-1573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNERSTONE BEHAVIORAL HEALTH INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-03",
        "last_updated": "2014-01-06",
        "status": "A",
        "authorized_official_last_name": "MORAN",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "774-253-1573",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "7013",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "7534",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "6209",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "3358",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "7497",
            "primary": false
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "MA",
            "license": "239917",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "RN198309",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2014; 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.