Elise C Magnuson, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PS 1242 Issued in ME

Practice address

251 Woodford St
Portland, ME 04103-5617

Phone

(207) 632-6965

Fax

(207) 761-8150

NPI assigned

Mar 8, 2007

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569283200000",
    "number": "1245361468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 WOODFORD ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041035617",
            "telephone_number": "207-632-6965",
            "fax_number": "207-761-8150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "251 WOODFORD ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041035617",
            "telephone_number": "207-632-6965",
            "fax_number": "207-761-8150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAGNUSON",
        "first_name": "ELISE",
        "middle_name": "C",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-08",
        "last_updated": "2019-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC11425",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "ME",
            "license": "PS 1242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Krystle Maestas, LPCC
• Maeve Grace Donnelly LLC
• Hannah Elizabeth Magee, LCSW
• Ariana Magliocco, LMSW/CC
• Ann K Magner, DO
• Erica Magnuson, RD
• Richard J Maguire, M.D.
• Justin Yee Mah, AGACNP
• Lydia Marie Mahan, PA-S
• Keila Mayes Maher, M.D.

• Psychologist in Portland, ME
• Providers in Portland, ME by specialty
• Psychologist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2019; 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.

Verify at the official NPI Registry.