Individual provider Active NPI

Karl J Buckley, LCSW

  • Clinical Social Worker
  • Westbrook, ME
National Provider Identifier
1306956602
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LC8681 Issued in ME
Practice address
123 Andover Rd
Westbrook, ME 04092-3848
Phone
(207) 761-2200
Fax
(207) 842-7773
NPI assigned
Aug 30, 2006
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LC8681 ME Primary

Addresses

Primary practice location

123 Andover Rd
Westbrook, ME 04092-3848

Mailing address

123 Andover Rd
Westbrook, ME 04092-3848
Phone (207) 761-2200

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
I20051227000467 ME Practitioner - Clinical Social Worker 1951323427 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LC8681MEMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth CurrentSince Dec 1, 2019 Accepting new patients
Maine Medical Partners CurrentSince Dec 1, 2019 Accepting new patients
Mainehealth Current Accepting new patients

Locations

22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179

78 Atlantic Pl
South Portland, ME 04106
Phone (207) 661-6654

123 Andover Rd
Westbrook, ME 04092
Phone (207) 761-2200

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1306956602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 ANDOVER RD",
            "city": "WESTBROOK",
            "state": "ME",
            "postal_code": "040923848",
            "telephone_number": "207-761-2200",
            "fax_number": "207-842-7773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 ANDOVER RD",
            "city": "WESTBROOK",
            "state": "ME",
            "postal_code": "040923848",
            "telephone_number": "207-761-2200",
            "fax_number": "207-842-7773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKLEY",
        "first_name": "KARL",
        "middle_name": "J",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC8681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westbrook, ME

Sources for this page

Verify at the official NPI Registry.