Active NPI
Alexis Petterson, LCSW
- Social Worker
- Bangor, ME
National Provider Identifier
1073156444
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- MC18211
- Practice address
- 42 Cedar St
Bangor, ME 04401-6433 - Phone
- (207) 922-4600
- Fax
- (207) 564-3975
- NPI assigned
- Oct 18, 2019
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | MC18211 | ME | Primary |
Addresses
Primary practice location
42 Cedar St
Bangor, ME 04401-6433
Mailing address
42 Cedar St
Bangor, ME 04401-6433
Phone (207) 922-4600
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | alanctot@chcs-me.org | Community Health and Counseling Services |
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 |
|---|---|---|---|
| MC18211 | ME | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636588800000",
"number": "1073156444",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "42 CEDAR ST",
"city": "BANGOR",
"state": "ME",
"postal_code": "044016433",
"telephone_number": "207-922-4600",
"fax_number": "207-564-3975"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "42 CEDAR ST",
"city": "BANGOR",
"state": "ME",
"postal_code": "044016433",
"telephone_number": "207-922-4600",
"fax_number": "207-564-3975"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTERSON",
"first_name": "ALEXIS",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-18",
"last_updated": "2021-11-11",
"certification_date": "2021-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "ME",
"license": "MC18211",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "alanctot@chcs-me.org",
"affiliation": "Y",
"endpointDescription": "email",
"affiliationName": "Community Health and Counseling Services",
"address_1": "30 High St",
"city": "Skowhegan",
"state": "ME",
"country_code": "US",
"postal_code": "049761828",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Bangor, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 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.