Active NPI
Keith Riley
- Mental Health Counselor
- Portland, ME
National Provider Identifier
1346625019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LC14061
- Practice address
- 30 Danforth St Ste 311
Portland, ME 04101-4574 - Phone
- (207) 774-6877
- Fax
- (207) 879-0761
- NPI assigned
- Jul 23, 2015
- Sex
- Male
- Sole proprietor
- No
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 | LC14061 | ME | Primary |
Addresses
Primary practice location
30 Danforth St Ste 311
Portland, ME 04101-4574
Mailing address
30 Danforth St Ste 311
Portland, ME 04101-4574
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992935662 | Medicaid | ME |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437609600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437609600000",
"number": "1346625019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 DANFORTH ST STE 311",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041014574"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 DANFORTH ST STE 311",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041014574",
"telephone_number": "207-774-6877",
"fax_number": "207-879-0761"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RILEY",
"first_name": "KEITH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-07-23",
"last_updated": "2015-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "ME",
"license": "LC14061",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1992935662",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.