Michaela Koveleskie, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PS2603 Issued in ME

Practice address

656 State St
Bangor, ME 04401-5609

Phone

(207) 941-4000

NPI assigned

Sep 12, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Specialty

Clinical Psychologist

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

State of MaineGroup PAC ID 7517875131, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• State of Maine

  • Psychiatric Hospital
  • Bangor, ME
  • NPI 1699776146
  Medicare reassignment Care Compare group NPD
• State of Maine

  • Psychiatric Hospital
  • Augusta, ME
  • NPI 1053319566
  NPD
• State of Maine

  • Community/Behavioral Health Agency
  • Bangor, ME
  • NPI 1184020091
  NPD

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

{
    "created_epoch": "1726099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1245066406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 BRICKETT POINT ESTS",
            "city": "OAKLAND",
            "state": "ME",
            "postal_code": "049634033",
            "telephone_number": "302-547-7342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "656 STATE ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044015609",
            "telephone_number": "207-941-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOVELESKIE",
        "first_name": "MICHAELA",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-12",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "RI",
            "license": "PS02286",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ME",
            "license": "PS2603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Guy Kositratna, M.D.
• Kelly Kossen
• Debra Bryant Kotredes, RPH
• Sydney L Kotredes, PNPC
• Thomas Lewis Kotredes, RPH
• Amaya Jenn Kozusko, MS, FNP-C
• Steven D Kozusko, MD, MED
• Gregory Paul Kramer, D.M.D.
• Joanna Catherine Krasinski, MSN, APRN, BC, COHNS
• Donald W Krause, MD

• Clinical Psychologist in Bangor, ME
• Providers in Bangor, ME by specialty
• Clinical Psychologist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.