Kristen Bouse, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LC10053 Issued in ME

Practice address

343 Forest Ave
Portland, ME 04101

Phone

(207) 874-1030

Fax

(207) 874-1044

NPI assigned

Oct 4, 2006

Last updated

May 11, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242000000000",
    "number": "1295820140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "343 FOREST AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04101",
            "telephone_number": "207-874-1030",
            "fax_number": "207-874-1044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "343 FOREST AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04101",
            "telephone_number": "207-874-1030",
            "fax_number": "207-874-1044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUSE",
        "first_name": "KRISTEN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2009-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ME",
            "license": "LC10053",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC10053",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "286000099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nancy R Boulanger, M.D.
• April Ritter Bourgoin, CRNA
• Jennifer H. Bourgoin, PSY.D.
• Jonathan Bourque, PHARMD
• Tiffany A Bourque, RN
• Joseph Boutin, OT
• Amy Santerian Boutselis, PA-C
• Andrew James Bove, LCSW
• Christopher T Bowe, MD
• Marcia Emily Bowen, CRNA

• Clinical Social Worker in Portland, ME
• Providers in Portland, 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 May 11, 2009; 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.