Jacqueline Surdan, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LMHC10002078 Issued in MA

Practice address

409 Lexington St
Waltham, MA 02452-0933

Phone

(781) 647-9976

NPI assigned

Mar 17, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Mental Health Counselor

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Center Psychotherapy LLCGroup PAC ID 4486181625, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Center Psychotherapy LLC

  • Mental Health Counselor
  • Winchester, MA
  • NPI 1962974949
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1584403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1902432396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 LEXINGTON ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024520933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 LEXINGTON ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024520933",
            "telephone_number": "781-647-9976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SURDAN",
        "first_name": "JACQUELINE",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-17",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "LMHC10002078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meghan Summerton, RBT
• Hyung Seok Sung
• Jinsil Kim Sung, M.D.
• Supportive Circle Home Care Inc
• Donicka Suprice
• Maxine Sushelsky, LMHC
• Charles Sutera III, DMD
• Erin M Sweeney, LMT
• Lindsey Sweet, PT
• Syndicare, LLC

• Mental Health Counselor in Waltham, MA
• Providers in Waltham, MA by specialty
• Mental Health Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.