Active NPI
Teyonda Hall
- Clinical Social Worker
- Portland, ME
National Provider Identifier
1235487067
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LC19838
- Practice address
- 181 Brackett St
Portland, ME 04102-3857 - Phone
- (207) 775-0105
- Fax
- (207) 775-1392
- NPI assigned
- Aug 28, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 11003089-3501 | UT | |
| Clinical Social Worker | 1041C0700X | LC19838 | ME | Primary |
Addresses
Primary practice location
181 Brackett St
Portland, ME 04102-3857
Mailing address
474 Main St
Springvale, ME 04083-1409
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11003089-3501 | UT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624233600000",
"number": "1235487067",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "474 MAIN ST",
"city": "SPRINGVALE",
"state": "ME",
"postal_code": "040831409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "181 BRACKETT ST",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041023857",
"telephone_number": "207-775-0105",
"fax_number": "207-775-1392"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALL",
"first_name": "TEYONDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-08-28",
"last_updated": "2021-06-21",
"certification_date": "2021-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "UT",
"license": "11003089-3501",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ME",
"license": "LC19838",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 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.