Individual provider Active NPI

Thomas A. Cannon, LCPC

  • Professional Counselor
  • Portland, ME
National Provider Identifier
1124352083
Registry record updated Apr 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
CC3836 Issued in ME
Practice address
165 Lancaster St
Portland, ME 04101-2406
Phone
(207) 874-1030
Fax
(207) 874-1044
NPI assigned
Sep 25, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2015

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 CC3836 ME Primary

Addresses

Primary practice location

165 Lancaster St
Portland, ME 04101-2406

Mailing address

78 Atlantic PL
South Portland, ME 04106-2316
Phone (207) 661-6654

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
I20240205004234 ME Practitioner - Mental Health Counselor 1658714811 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spurwink Services IncorporatedGroup PAC ID 7810026945, 87 clinicians

Practice addresses (Care Compare)

901 Washington Ave
Suite 100
Portland, ME 04103-2842
Phone (207) 871-1200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CC3836MEMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Spurwink Services Incorporated CurrentSince Jan 1, 2024 Accepting new patients
Spurwink Services Incorporated PastSince Jan 1, 2024 Accepting new patients

Locations

139 State St
#1
Bangor, ME 04401

901 Washington Ave
Ste 100
Portland, ME 04103
Phone 20787112112145

9 Hillcrest Ave
Randolph, ME 04346
Phone (207) 582-9205

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1253836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429488000000",
    "number": "1124352083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "78 ATLANTIC PL",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041062316",
            "telephone_number": "207-661-6654",
            "fax_number": "207-842-7773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 LANCASTER ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041012406",
            "telephone_number": "207-874-1030",
            "fax_number": "207-874-1044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "THOMAS",
        "middle_name": "A.",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-25",
        "last_updated": "2015-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ME",
            "license": "CC3836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.