Brian C Gamboa

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

3 Ashlawn Rd
Assonet, MA 02702-1105

Phone

(508) 933-5205

Fax

(877) 308-2202

NPI assigned

Oct 8, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

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, 2010

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• TLJ, Inc.

  • Professional Counselor
  • Dartmouth, MA
  • NPI 1467911990
  NPD (past)

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

{
    "created_epoch": "1286496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612310400000",
    "number": "1942510052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 ASHLAWN RD",
            "city": "ASSONET",
            "state": "MA",
            "postal_code": "027021105",
            "telephone_number": "508-933-5205",
            "fax_number": "877-308-2202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 ASHLAWN RD",
            "city": "ASSONET",
            "state": "MA",
            "postal_code": "027021105",
            "telephone_number": "508-933-5205",
            "fax_number": "877-308-2202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAMBOA",
        "first_name": "BRIAN",
        "middle_name": "C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-08",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Springs, Inc.
• Crystal Springs, Inc.
• Karen Cummings, LICSW
• Kathryn Lee Davis, CCC-SLP
• Derek M Cornetta, DDS, PC
• Erin Gilhooly-Smith, M.S. CCC-SLP
• Susan Grenier
• Cathy J Grinham, RDH
• Christine Ann Griswold
• H and L

• Mental Health Counselor in Assonet, MA
• Providers in Assonet, 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 Feb 3, 2021; 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.