Active NPI
Jack Mazzotti
- Mental Health Counselor
- Worcester, MA
National Provider Identifier
1942967021
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 10562
- Practice address
- 255 Park Ave Ste 900
Worcester, MA 01609-1978 - Phone
- (508) 753-7902
- NPI assigned
- Nov 23, 2021
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 10562 | MA | Primary |
Addresses
Primary practice location
255 Park Ave Ste 900
Worcester, MA 01609-1978
Mailing address
255 Park Ave Ste 900
Worcester, MA 01609-1978
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 |
|---|---|---|---|
| 10562 | MA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1637625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637625600000",
"number": "1942967021",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "255 PARK AVE STE 900",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016091978"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "255 PARK AVE STE 900",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016091978",
"telephone_number": "508-753-7902"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAZZOTTI",
"first_name": "JACK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-11-23",
"last_updated": "2021-11-23",
"certification_date": "2021-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MA",
"license": "10562",
"primary": true
}
],
"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 Nov 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.