Kenneth A. Beattie, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PS1018 Issued in ME

Practice address

64 Church St
Ellsworth, ME 04605-1658

Phone

(207) 669-6011

Fax

(207) 669-6011

NPI assigned

Jul 26, 2006

Sex

Male

Sole proprietor

Yes

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.

• Tideside Clinical & Psychological Services

  • Clinical Psychologist
  • Ellsworth, ME
  • NPI 1275645939

  Clinical

  NPD (past) Authorized official

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 9, 2007.

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1023032869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "94 MILL ST",
            "city": "ORONO",
            "state": "ME",
            "postal_code": "044734040",
            "telephone_number": "207-669-6011",
            "fax_number": "207-669-6011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64 CHURCH ST",
            "city": "ELLSWORTH",
            "state": "ME",
            "postal_code": "046051658",
            "telephone_number": "207-669-6011",
            "fax_number": "207-669-6011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEATTIE",
        "first_name": "KENNETH",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ME",
            "license": "PS1018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "336970000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Ellsworth, ME
• Clinical Psychologist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.