Individual provider Active NPI

Thomas P Riddell, LCPC

  • Professional Counselor
  • Saco, ME
National Provider Identifier
1073829230
Registry record updated Aug 26, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
CC1974 Issued in ME
Practice address
50 Moody St
Saco, ME 04072-1536
Phone
(800) 434-3000
NPI assigned
Aug 26, 2010
Last updated
Aug 26, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X CC1974 ME Primary

Addresses

Primary practice location

50 Moody St
Saco, ME 04072-1536

Mailing address

50 Moody St
Saco, ME 04072-1536
Phone (800) 434-3000

Other identifiers 1

IdentifierTypeStateIssuer
265200099MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240604003135 ME Practitioner - Mental Health Counselor 4082054382 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CC1974MEMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Port Resources CurrentSince Apr 23, 2024 Accepting new patients

Locations

280 Gannett Dr
Ste B
South Portland, ME 04106
Phone (207) 828-0048

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1282780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282780800000",
    "number": "1073829230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 MOODY ST",
            "city": "SACO",
            "state": "ME",
            "postal_code": "040721536",
            "telephone_number": "800-434-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 MOODY ST",
            "city": "SACO",
            "state": "ME",
            "postal_code": "040721536",
            "telephone_number": "800-434-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDDELL",
        "first_name": "THOMAS",
        "middle_name": "P",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-26",
        "last_updated": "2010-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ME",
            "license": "CC1974",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "265200099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saco, ME

Sources for this page

Verify at the official NPI Registry.