Active NPI
Nicholas Moallem
- Mental Health Counselor
- Cambridge, MA
National Provider Identifier
1912400110
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 12821-MH-CC.
- Practice address
- 12 Inman St
Cambridge, MA 02139-2423 - Phone
- (779) 537-2243
- NPI assigned
- Mar 14, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 12821-MH-CC. | MA | Primary |
| Behavior Analyst | 103K00000X |
Addresses
Primary practice location
12 Inman St
Cambridge, MA 02139-2423
Mailing address
71 Williams St Apt 3
Jamaica Plain, MA 02130-3856
Phone (779) 537-2243
Other practice location 1
71 Williams St Apt 3
Jamaica Plain, MA 02130-3856
Phone (779) 537-2243
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12821-MH-CC. | Other | MA | LMHC LICENSE NUMBER |
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 |
|---|---|---|---|
| 12821-MH-CC. | MA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bluebird Counseling and Psychotherapy | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Rockford, IL
- NPI 1669240156
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1520985600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647302400000",
"number": "1912400110",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "71 WILLIAMS ST APT 3",
"city": "JAMAICA PLAIN",
"state": "MA",
"postal_code": "021303856",
"telephone_number": "779-537-2243"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 INMAN ST",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021392423",
"telephone_number": "779-537-2243"
}
],
"practiceLocations": [
{
"address_1": "71 Williams St Apt 3",
"address_purpose": "LOCATION",
"city": "Jamaica Plain",
"state": "MA",
"postal_code": "021303856",
"country_code": "US",
"telephone_number": "779-537-2243",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MOALLEM",
"first_name": "NICHOLAS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-03-14",
"last_updated": "2022-03-15",
"certification_date": "2022-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MA",
"license": "12821-MH-CC.",
"primary": true
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LMHC LICENSE NUMBER",
"identifier": "12821-MH-CC.",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cambridge, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.