Michael B. Ivy, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LC16866 Issued in ME

Practice address

110 Main St Ste 1508
Saco, ME 04072-3517

Phone

(207) 807-9110

Fax

(207) 560-9860

NPI assigned

Sep 28, 2015

Last updated

Apr 28, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• George E Abboud MD PA

  • Specialist
  • Biddeford, ME
  • NPI 1972787620
  NPD (past)

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

{
    "created_epoch": "1443398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651104000000",
    "number": "1265802698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 PINE COUNTRY DR",
            "city": "BUXTON",
            "state": "ME",
            "postal_code": "040936447",
            "telephone_number": "207-807-9110",
            "fax_number": "207-560-9860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 MAIN ST STE 1508",
            "city": "SACO",
            "state": "ME",
            "postal_code": "040723517",
            "telephone_number": "207-807-9110",
            "fax_number": "207-560-9860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVY",
        "first_name": "MICHAEL",
        "middle_name": "B.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-09-28",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC16866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Inner Warrior, LLC
• Integrative Psychiatry of Maine
• Samantha L Ireland, LCPC-C
• Island Institute for Trauma Recovery LLC
• Island Point Dentistry LLC, P.a.
• Jessica Marie Jackson, ATC
• Shannon Jackson, LPN
• Melissa B Jacques
• Tracy Jamison
• Jay a. Beauchemin, DDS, PA

• Clinical Social Worker in Saco, ME
• Providers in Saco, ME by specialty
• Clinical Social Worker in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; 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.