Active NPI
Glen T Prospere
- Mental Health Counselor
- Boston, MA
National Provider Identifier
1912135666
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 6911
- Practice address
- 1601 Washington Street
Boston, MA 02118-1951 - Phone
- (617) 425-2000
- Fax
- (617) 424-8725
- NPI assigned
- Jul 1, 2009
- Last updated
- Jul 6, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 6911 | MA | Primary |
Addresses
Primary practice location
1601 Washington Street
Boston, MA 02118-1951
Mailing address
43 Pierce Street
Hyde Park, MA 02136
Phone (617) 364-9464
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6911 | MA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1246406400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1246838400000",
"number": "1912135666",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "43 PIERCE STREET",
"city": "HYDE PARK",
"state": "MA",
"postal_code": "02136",
"telephone_number": "617-364-9464"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 WASHINGTON STREET",
"city": "BOSTON",
"state": "MA",
"postal_code": "021181951",
"telephone_number": "617-425-2000",
"fax_number": "617-424-8725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROSPERE",
"first_name": "GLEN",
"middle_name": "T",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-07-01",
"last_updated": "2009-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MA",
"license": "6911",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.