Active NPI
Michael Vriesman, PHD
- Clinical Psychologist
- Bangor, ME
National Provider Identifier
1134575145
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301019409
- Practice address
- 35 State Hospital Dr
Bangor, ME 04401-8816 - Phone
- (877) 421-8263
- NPI assigned
- May 9, 2016
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301019409 | MI | Primary |
Addresses
Primary practice location
35 State Hospital Dr
Bangor, ME 04401-8816
Mailing address
G3230 Beecher Rd Ste 1
Flint, MI 48532-3604
Phone (810) 342-5656
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301019409 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1462752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740700800000",
"number": "1134575145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "G3230 BEECHER RD STE 1",
"city": "FLINT",
"state": "MI",
"postal_code": "485323604",
"telephone_number": "810-342-5656",
"fax_number": "810-342-5600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "35 STATE HOSPITAL DR",
"city": "BANGOR",
"state": "ME",
"postal_code": "044018816",
"telephone_number": "877-421-8263"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VRIESMAN",
"first_name": "MICHAEL",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-05-09",
"last_updated": "2025-02-28",
"certification_date": "2025-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301019409",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"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 Feb 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.