Bradley Antenore, MSW-CC
Individual provider Active NPI Counselor · Biddeford, ME
NPI 1356124804 · NPPES record last updated Aug 17, 2023
Key facts
- NPI
- 1356124804
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- MC21491 (ME)
- Practice address
- 419 Alfred St
Biddeford, ME 04005-3747 - Phone
- (207) 494-8010
- NPI assigned
- Aug 17, 2023
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2022
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
419 Alfred St
Biddeford, ME 04005-3747
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ME
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250715000702 | ME | Practitioner - Clinical Social Worker | 9234644691 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MC21491 | ME | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alternative Wellness Services | Current |
Accepting new patients | |
| Primecare Physician Associates | Past |
Accepting new patients |
Locations
419 Alfred St
Biddeford, ME 04005
Phone (207) 282-9080
411 Alfred St
Biddeford, ME 04005
Phone (207) 284-4586
525 Forest Ave
Portland, ME 04101
Phone (207) 415-8654
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | MC21491 | ME | Yes |
Addresses
Primary practice location
419 Alfred St
Biddeford, ME 04005-3747
Mailing address
419 Alfred St
Biddeford, ME 04005-3747
Phone (207) 494-8010
Other providers in Biddeford, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.