Individual provider Active NPI

Kaitlin P Zwerdling, LCPC-C

  • Professional Counselor
  • Bangor, ME
National Provider Identifier
1336863059
Registry record updated Jul 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
XL6881 Issued in ME
Practice address
86 Davis Rd
Bangor, ME 04401-2311
Phone
(207) 992-2205
Fax
(207) 992-2207
NPI assigned
Sep 27, 2022
Last updated
Jul 30, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X XL6881 ME
Professional Counselor 101YP2500X XL6881 ME Primary

Addresses

Primary practice location

86 Davis Rd
Bangor, ME 04401-2311

Mailing address

PO Box 1599
Bangor, ME 04402-1599
Phone (207) 404-8200

Other names 1

  • Kaitlin Drake Former name

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
I20241008003363 ME Practitioner - Mental Health Counselor 6204367782 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Penobscot Community Health CenterGroup PAC ID 0143212670, 135 clinicians

Practice addresses (Care Compare)

1012 Union St
Bangor, ME 04401-3058

1068 Union St
Bangor, ME 04401-3016
Phone (207) 404-8181

181 Corporate Dr
Bangor, ME 04401-4314
Phone (207) 992-2636

30 Summer St
Bangor, ME 04401-6467
Phone (207) 404-8383

6 Telcom Dr
Bangor, ME 04401-3072
Phone (207) 941-2850

735 Wilson St
Brewer, ME 04412-1000
Phone (207) 989-1567

992 Union St
Bangor, ME 04401-3057

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
XL6881MEMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Penobscot Community Health Center CurrentSince Sep 26, 2024 Accepting new patients
Solstice Maine Counseling, LLC Mental Health Current Accepting new patients
Penobscot Community Health Center CurrentSince Sep 26, 2024 Accepting new patients

Locations

1012 Union St
Ste 1
Bangor, ME 04401
Phone 2079455247407

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": "1664236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722297600000",
    "number": "1336863059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1599",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044021599",
            "telephone_number": "207-404-8200",
            "fax_number": "207-947-0435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86 DAVIS RD",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044012311",
            "telephone_number": "207-992-2205",
            "fax_number": "207-992-2207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZWERDLING",
        "first_name": "KAITLIN",
        "middle_name": "P",
        "credential": "LCPC-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-27",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ME",
            "license": "XL6881",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ME",
            "license": "XL6881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAITLIN",
            "last_name": "DRAKE",
            "credential": "LCPC-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.