Nicholas Jon Pelkey, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

LC5699 Issued in ME

Practice address

96 Harlow St
Suite 360
Bangor, ME 04401-4925

Phone

(207) 945-9777

Fax

(207) 945-9780

NPI assigned

Jul 12, 2011

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1310428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582848000000",
    "number": "1013205053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "96 HARLOW ST",
            "address_2": "SUITE 360",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014925",
            "telephone_number": "207-945-9777",
            "fax_number": "207-945-9780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96 HARLOW ST",
            "address_2": "SUITE 360",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014925",
            "telephone_number": "207-945-9777",
            "fax_number": "207-945-9780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELKEY",
        "first_name": "NICHOLAS",
        "middle_name": "JON",
        "credential": "LADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-12",
        "last_updated": "2020-02-28",
        "certification_date": "2020-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "ME",
            "license": "LC5699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Craig J Pedersen, PA-C
• Jared Peet, CADC
• Elizabeth R Pelissier, APRN
• David E Pelkey, LADC
• Lisa V Pelkey, FNP
• Amelia Maya Pellegrini, PHD
• Joanmarie Dietz Pellegrini, M.D.
• Tammy Anne Pellegrino, OT
• Cheryl S Pelletier, PHD
• Darren R Pelletier, M.S., PA-C

• All providers in Bangor, ME
• Addiction (Substance Use Disorder) Counselor in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.