Active NPI
Mary Lavina Fredricks, LCSW
- Clinical Social Worker
- Livermore Falls, ME
National Provider Identifier
1376510412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- ME129365
- Practice address
- 38 Union St
Livermore Falls, ME 04254 - Phone
- (207) 897-6601
- Fax
- (207) 897-4339
- NPI assigned
- Mar 8, 2006
- Last updated
- Nov 15, 2012
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | ME129365 | ME | Primary |
Addresses
Primary practice location
38 Union St
Livermore Falls, ME 04254
Mailing address
38 Union St
Livermore Falls, ME 04254
Phone (207) 897-6601
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 218840099 | Medicaid | ME | |
| 047005 | Other | ME | ANTHEM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141776000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352937600000",
"number": "1376510412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "38 UNION ST",
"city": "LIVERMORE FALLS",
"state": "ME",
"postal_code": "04254",
"telephone_number": "207-897-6601",
"fax_number": "207-897-4339"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "38 UNION ST",
"city": "LIVERMORE FALLS",
"state": "ME",
"postal_code": "04254",
"telephone_number": "207-897-6601",
"fax_number": "207-897-4339"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDRICKS",
"first_name": "MARY",
"middle_name": "LAVINA",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-03-08",
"last_updated": "2012-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ME",
"license": "ME129365",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "218840099",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "047005",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Livermore Falls, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.