Individual provider Active NPI

Stephen Robert Andrew, LCSW, LADC

  • Clinical Social Worker
  • Portland, ME
National Provider Identifier
1265704837
Registry record updated Jan 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LC5492 Issued in ME
Practice address
25 Middle St
Portland, ME 04101-4869
Phone
(207) 773-9724
Fax
(207) 773-7386
NPI assigned
Jan 30, 2012
Last updated
Jan 30, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 30, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X LC1358 ME
Clinical Social Worker 1041C0700X LC5492 ME Primary

Addresses

Primary practice location

25 Middle St
Portland, ME 04101-4869

Mailing address

25 Middle St
Portland, ME 04101-4869
Phone (207) 773-9724

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
I20161004002062 ME Practitioner - Clinical Social Worker 9234427485 Practice locations: Portland, ME

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LC1358MEMDAddiction (Substance Use Disorder) Counselor

NPI Registry JSON

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

{
    "created_epoch": "1327881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327881600000",
    "number": "1265704837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 MIDDLE ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041014869",
            "telephone_number": "207-773-9724",
            "fax_number": "207-773-7386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 MIDDLE ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041014869",
            "telephone_number": "207-773-9724",
            "fax_number": "207-773-7386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDREW",
        "first_name": "STEPHEN",
        "middle_name": "ROBERT",
        "credential": "LCSW, LADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-01-30",
        "last_updated": "2012-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "ME",
            "license": "LC1358",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC5492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.