Southwestern Maine Clinical Assoc PA

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PS574 Issued in ME

Legal business name

SOUTHWESTERN MAINE CLINICAL ASSOC PA

Practice address

20 Mechanic St
Gorham, ME 04038

Phone

(207) 839-2587

Fax

(207) 839-2022

NPI assigned

Feb 9, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Kerry E Kimball, EDDNPI 1770768921

Title

Ceo

Phone

(207) 839-2587

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kerry Kimball, E.D.D

  • Clinical Psychologist
  • Gorham, ME
  • NPI 1770768921
  NPD (past) Authorized official

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

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208995200000",
    "number": "1265405385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 757",
            "city": "GORHAM",
            "state": "ME",
            "postal_code": "040380757",
            "telephone_number": "207-839-2587",
            "fax_number": "207-839-2022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 MECHANIC ST",
            "city": "GORHAM",
            "state": "ME",
            "postal_code": "04038",
            "telephone_number": "207-839-2587",
            "fax_number": "207-839-2022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWESTERN MAINE CLINICAL ASSOC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-09",
        "last_updated": "2008-04-24",
        "status": "A",
        "authorized_official_last_name": "KIMBALL",
        "authorized_official_first_name": "KERRY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-839-2587",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "EDD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "ME",
            "license": "PS574",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125580000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Earl Smith, PT ATC
• Samantha Smith
• Soul Wisdom Counseling
• Southern Maine in Home Therapy Services,LLC
• Southern Maine Pediatric Therapies, PLLC
• Matthew Steinback, MLADC, LADC, CCS
• Cordell Stuart, RPH
• Sami-Jo Stubbs, LCSW
• Andee R Stynchula, ND
• Rachel L. Sullivan, PA-C

• All providers in Gorham, ME
• Psychologist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.