Individual provider Active NPI

Travis Jerome Lenfest, LCSW, LADC, CCS

  • Clinical Social Worker
  • Bangor, ME
National Provider Identifier
1295123222
Registry record updated Mar 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LC18074 Issued in ME
Practice address
139 State St Ste 2
Bangor, ME 04401-5317
Phone
(207) 631-8968
NPI assigned
Dec 29, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X CCS5117 ME
Addiction (Substance Use Disorder) Counselor 101YA0400X LC4633 ME
Clinical Social Worker 1041C0700X LC18074 ME Primary

Addresses

Primary practice location

139 State St Ste 2
Bangor, ME 04401-5317

Mailing address

139 State St Ste 2
Bangor, ME 04401-5317
Phone (207) 631-8968

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
I20220629002480 ME Practitioner - Clinical Social Worker 8426438094 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Health Affiliates Maine, LLCGroup PAC ID 1951594076, 169 clinicians

Practice addresses (Care Compare)

306 Rodman Rd
Auburn, ME 04210-3830
Phone (207) 333-3278

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CCS5117MEMDAddiction (Substance Use Disorder) Counselor
LC4633MEMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Health Affiliates Maine, LLC CurrentSince Mar 17, 2022 Accepting new patients

Locations

306 Rodman Rd
Auburn, ME 04210
Phone (207) 333-3278

Organizations & group practices 1

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": "1419811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648684800000",
    "number": "1295123222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 STATE ST STE 2",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044015317",
            "telephone_number": "207-631-8968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 STATE ST STE 2",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044015317",
            "telephone_number": "207-631-8968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LENFEST",
        "first_name": "TRAVIS",
        "middle_name": "JEROME",
        "credential": "LCSW, LADC, CCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-12-29",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "ME",
            "license": "CCS5117",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "ME",
            "license": "LC4633",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC18074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.