Tideside Clinical & Psychological Services

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PS1018 Issued in ME

Legal business name

TIDESIDE CLINICAL & PSYCHOLOGICAL SERVICES

Practice address

64 Church St
Tideside
Ellsworth, ME 04605-1658

Phone

(207) 669-6011

Fax

(207) 669-6011

NPI assigned

Aug 31, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Kenneth A. Beattie, PH.D.NPI 1023032869

Title

Sole Owner

Phone

(207) 669-6011

Specialties & licenses 1

Addresses

Other names 1

• Tideside Other name

Practitioners 2

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

• Kenneth A. Beattie, PH.D.

  • Clinical Psychologist
  • Ellsworth, ME
  • NPI 1023032869

  Clinical

  NPD (past) Authorized official
• Geoffrey Lascelles Thorpe, PH.D.

  • Clinical Psychologist
  • Ellsworth, ME
  • NPI 1184784803

  Clinical

  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1275645939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "94 MILL ST",
            "city": "ORONO",
            "state": "ME",
            "postal_code": "044734040",
            "telephone_number": "207-866-2636",
            "fax_number": "207-669-6011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64 CHURCH ST",
            "address_2": "TIDESIDE",
            "city": "ELLSWORTH",
            "state": "ME",
            "postal_code": "046051658",
            "telephone_number": "207-669-6011",
            "fax_number": "207-669-6011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDESIDE CLINICAL & PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BEATTIE",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "207-669-6011",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "ME",
            "license": "PS1018",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tideside",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Tracey Tarr, LADC
• Kirk Brown Taylor, LCSW
• Tamara L Thomas
• Erica L. Thompson, MHRT-CSP
• Geoffrey Lascelles Thorpe, PH.D.
• Anna Titcomb
• William R Toles, COTA/L
• Maryellen B. Toothaker, MA,CCC-A
• Total Renal Care Inc
• Melissa Tozier

• All providers in Ellsworth, ME
• Clinical Psychologist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.