Individual provider Active NPI

Tara K. Pullen, LCSW

  • Clinical Social Worker
  • Sanford, ME
National Provider Identifier
1245435007
Registry record updated Nov 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LC9957 Issued in ME
Practice address
4 Washington St
Suite 300
Sanford, ME 04073-3031
Phone
(207) 318-4831
NPI assigned
Jun 20, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 20, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LC9957 ME Primary

Addresses

Primary practice location

4 Washington St
Suite 300
Sanford, ME 04073-3031

Mailing address

49 Plantation LN
Wells, ME 04090-6466
Phone (207) 318-4831

Other identifiers 1

IdentifierTypeStateIssuer
431537699MedicaidME

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20100303000686 ME Practitioner - Clinical Social Worker 9133264054 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SweetserGroup PAC ID 8325946213, 138 clinicians

Practice addresses (Care Compare)

329 Bath Rd
Brunswick, ME 04011-2673
Phone (207) 373-3177

50 Moody St
Saco, ME 04072-1536
Phone (800) 434-3000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LC9957MEMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Sweetser CurrentSince Jul 1, 2014 Accepting new patients
Maine Behavioral Healthcare Past Accepting new patients

Locations

329 Bath Rd
Brunswick, ME 04011
Phone (207) 373-3012

50 Moody St
Saco, ME 04072
Phone (207) 284-5981

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1182297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353369600000",
    "number": "1245435007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 PLANTATION LN",
            "city": "WELLS",
            "state": "ME",
            "postal_code": "040906466",
            "telephone_number": "207-318-4831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 WASHINGTON ST",
            "address_2": "SUITE 300",
            "city": "SANFORD",
            "state": "ME",
            "postal_code": "040733031",
            "telephone_number": "207-318-4831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PULLEN",
        "first_name": "TARA",
        "middle_name": "K.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-20",
        "last_updated": "2012-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC9957",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "431537699",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sanford, ME

Sources for this page

Verify at the official NPI Registry.