| Department Of Mental Health - Mass Mental Health Center | |
|
20 Vining St Boston MA 02115-6115 | |
| (617) 626-9459 | |
| Not Available |
| Full Name | Department Of Mental Health - Mass Mental Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 20 Vining St, Boston, Massachusetts |
| Authorized Official Name and Position | Regina Marshall (CENTER DIRECTOR) |
| Authorized Official Contact | 6176269459 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Department Of Mental Health - Mass Mental Health Center 75 Fenwood Rd Boston MA 02115-6103 Ph: (617) 626-9459 | Department Of Mental Health - Mass Mental Health Center 20 Vining St Boston MA 02115-6115 Ph: (617) 626-9459 |
| NPI Number | 1568587913 |
|---|---|
| Provider Enumeration Date | 03/21/2007 |
| Last Update Date | 10/24/2014 |
| Medicare PECOS PAC ID | 8820906860 |
|---|---|
| Medicare Enrollment ID | O20040527000489 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568587913 | NPI | - | NPPES |
| 1310062 | Medicaid | MA | |
| 1310046 | Medicaid | MA | |
| Y10406 | Other | MA | MEDICARE PART B |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Kamel M Gherbi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174603237 PECOS PAC ID: 3678545951 Enrollment ID: I20040807000213 |
| Provider Name | James J Feldman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427145028 PECOS PAC ID: 8729004916 Enrollment ID: I20051017001118 |
| Provider Name | Eileen C Reilly |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902983646 PECOS PAC ID: 8123039120 Enrollment ID: I20060505000053 |
| Provider Name | Rosaura Cruz |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538384839 PECOS PAC ID: 5395838809 Enrollment ID: I20070829000508 |
| Provider Name | Ginger Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942422522 PECOS PAC ID: 0749357259 Enrollment ID: I20080925000441 |
| Provider Name | Juan R Condemarin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083894059 PECOS PAC ID: 1759419971 Enrollment ID: I20100510000386 |
| Provider Name | Svetlana Moore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518174572 PECOS PAC ID: 3870622582 Enrollment ID: I20100518000641 |
| Provider Name | Ann Findeisen |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1336360387 PECOS PAC ID: 0547399263 Enrollment ID: I20100518000708 |
| Provider Name | Marisol Segundo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821164930 PECOS PAC ID: 3072647163 Enrollment ID: I20100811000278 |
| Provider Name | Elizabeth Marie Templeton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124273131 PECOS PAC ID: 7719138767 Enrollment ID: I20121121000413 |
| Provider Name | Jeff Richard Woodworth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104041714 PECOS PAC ID: 1355594870 Enrollment ID: I20130114000186 |
| Provider Name | Lauren Rebecca Costello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992087134 PECOS PAC ID: 8729232780 Enrollment ID: I20130129000500 |
| Provider Name | Paul Vincent Wikstrom |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952495053 PECOS PAC ID: 2567600836 Enrollment ID: I20130528000235 |
| Provider Name | Rudolph Lawrence Blier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861695561 PECOS PAC ID: 5294973301 Enrollment ID: I20130531000428 |
| Provider Name | Jeffrey Eisen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326280223 PECOS PAC ID: 1951545177 Enrollment ID: I20130910000176 |
| Provider Name | Kathryn J Tompkins |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427360395 PECOS PAC ID: 2668631169 Enrollment ID: I20140807002429 |
| Provider Name | Gina Marie Gambardella |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124163092 PECOS PAC ID: 1850613639 Enrollment ID: I20141205000666 |
| Provider Name | Anne Oldshue Calabresi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245296441 PECOS PAC ID: 8426379389 Enrollment ID: I20150603001773 |
| Provider Name | Meher Makda |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851843510 PECOS PAC ID: 9436419660 Enrollment ID: I20180208002242 |
| Provider Name | Christopher R Hutchison-jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285045930 PECOS PAC ID: 4385996180 Enrollment ID: I20181005000528 |
| Provider Name | Ashley Rose Brann |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881045284 PECOS PAC ID: 2264784081 Enrollment ID: I20181005001715 |
| Provider Name | Erika Nicole Marques |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033690532 PECOS PAC ID: 6204225824 Enrollment ID: I20211119000355 |
| Provider Name | Peter L Rakes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104413681 PECOS PAC ID: 6406249135 Enrollment ID: I20220202000314 |
| Provider Name | Chia Hsuan Sabrina Chang |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1023642865 PECOS PAC ID: 8325434194 Enrollment ID: I20220404000719 |
| Provider Name | Amy Keresztes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093184327 PECOS PAC ID: 6204222573 Enrollment ID: I20220413002415 |
| Provider Name | Christopher Charles Reardon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578946760 PECOS PAC ID: 3870980899 Enrollment ID: I20220421001860 |
| Provider Name | Laura Leigh Falotico |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548742075 PECOS PAC ID: 2365821758 Enrollment ID: I20220615000123 |
| Provider Name | Kaitlyn Elyssa Rocha |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184072910 PECOS PAC ID: 2860863818 Enrollment ID: I20230130002055 |
| Provider Name | Kristen Eve Fletcher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104499862 PECOS PAC ID: 4082079694 Enrollment ID: I20230504001774 |
| Provider Name | Olanrewaju Oludotun Onifade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881362515 PECOS PAC ID: 2860889334 Enrollment ID: I20230517001858 |
| Provider Name | Derick Yensila Ngoran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932719135 PECOS PAC ID: 5698186864 Enrollment ID: I20231013001840 |
| Provider Name | Carola Mallol |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568680817 PECOS PAC ID: 5294174637 Enrollment ID: I20240417002938 |
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