Active NPI
Cherie Gustafson, M.A.
- Mental Health Counselor
- South Portland, ME
National Provider Identifier
1306889530
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- CC1639
- Practice address
- 505R Ocean St
South Portland, ME 04106-6615 - Phone
- (207) 808-9820
- NPI assigned
- Jun 14, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | CC1639 | ME | Primary |
Addresses
Primary practice location
505R Ocean St
South Portland, ME 04106-6615
Mailing address
50 Market Street
Suite 1a Box 212
South Portland, ME 04106-3646
Phone (207) 808-9820
Other practice location 1
25 Jewett Rd
Cape Elizabeth, ME 04107-2428
Phone (207) 808-9820
Other practice location 2
95 High St Ste 307
Portland, ME 04101-3820
Phone (207) 808-8920
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 4, 2024 through Jan 4, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CC1639 | ME | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656028800000",
"number": "1306889530",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 MARKET STREET",
"address_2": "SUITE 1A BOX 212",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041063646",
"telephone_number": "207-808-9820"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "505R OCEAN ST",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041066615",
"telephone_number": "207-808-9820"
}
],
"practiceLocations": [
{
"address_1": "25 Jewett Rd",
"address_purpose": "LOCATION",
"city": "Cape Elizabeth",
"state": "ME",
"postal_code": "041072428",
"country_code": "US",
"telephone_number": "207-808-9820",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "95 High St Ste 307",
"address_purpose": "LOCATION",
"city": "Portland",
"state": "ME",
"postal_code": "041013820",
"country_code": "US",
"telephone_number": "207-808-8920",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GUSTAFSON",
"first_name": "CHERIE",
"name_prefix": "Ms.",
"credential": "M.A.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-06-14",
"last_updated": "2022-06-24",
"certification_date": "2022-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "ME",
"license": "CC1639",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.