Active NPI
Katie Janessa Tyler, LCSW
- Clinical Social Worker
- Augusta, ME
National Provider Identifier
1124555438
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- MC16433
- Practice address
- 18 Meadow Rd
Augusta, ME 04330-4915 - Phone
- (207) 441-4482
- NPI assigned
- May 17, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | MC16433 | ME | Primary |
Addresses
Primary practice location
18 Meadow Rd
Augusta, ME 04330-4915
Mailing address
PO Box 5641
Augusta, ME 04332-5641
Phone (207) 623-1898
Other practice location 1
545 Riverside Dr
Augusta, ME 04330-3831
Phone (207) 623-1898
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 |
|---|---|---|---|
| MC16433 | ME | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1494979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648598400000",
"number": "1124555438",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5641",
"city": "AUGUSTA",
"state": "ME",
"postal_code": "043325641",
"telephone_number": "207-623-1898"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18 MEADOW RD",
"city": "AUGUSTA",
"state": "ME",
"postal_code": "043304915",
"telephone_number": "207-441-4482"
}
],
"practiceLocations": [
{
"address_1": "545 Riverside Dr",
"address_purpose": "LOCATION",
"city": "Augusta",
"state": "ME",
"postal_code": "043303831",
"country_code": "US",
"telephone_number": "207-623-1898",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TYLER",
"first_name": "KATIE",
"middle_name": "JANESSA",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-05-17",
"last_updated": "2022-03-30",
"certification_date": "2022-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ME",
"license": "MC16433",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Augusta, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.