Individual provider Active NPI

Theresa A. Simpson, LCSW

  • Clinical Social Worker
  • Portland, ME
National Provider Identifier
1376778449
Registry record updated May 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LC6842 Issued in ME
Practice address
84 Marginal Way
Portland, ME 04101-2443
Phone
(207) 774-5816
Fax
(207) 523-8595
NPI assigned
May 19, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2019

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 LC6842 ME Primary

Addresses

Primary practice location

84 Marginal Way
Portland, ME 04101-2443

Mailing address

100 Gannett Drive
Suite C
South Portland, ME 04106
Phone (207) 523-3649

Other identifiers 1

IdentifierTypeStateIssuer
432087899MedicaidME

Other names 1

  • Theresa Anne Martin 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
I20050524000850 ME Practitioner - Clinical Social Worker 0941242531 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Counseling Center of Nashua IncGroup PAC ID 3274523758, 250 clinicians

Practice addresses (Care Compare)

707 Sable Oaks Dr
Suite 230
South Portland, ME 04106-6954
Phone (603) 883-0005

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth CurrentSince Jan 1, 2019 Accepting new patients
Mainehealth CurrentSince Jan 1, 2019 Accepting new patients
Mainehealth Current Accepting new patients
The Counseling Center of Nashua Inc Clinical CurrentSince Jan 1, 2024 Accepting new patients
Integrated Behavioral Healthcare Past Accepting new patients

Locations

53 Baxter Blvd
Ste 3
Portland, ME 04101
Phone (207) 613-4115

53 Baxter Blvd
Portland, ME 04101
Phone (207) 245-1648

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

11 Baxter Blvd
Fl 2
Portland, ME 04101
Phone (207) 306-9900

707 Sable Oaks Dr
Ste 230
South Portland, ME 04106
Phone (207) 774-8700

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

1 Main St
Nashua, NH 03064
Phone (603) 689-7978

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1242691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558483200000",
    "number": "1376778449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 GANNETT DRIVE",
            "address_2": "SUITE C",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "04106",
            "telephone_number": "207-523-3649",
            "fax_number": "207-874-1483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "84 MARGINAL WAY",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041012443",
            "telephone_number": "207-774-5816",
            "fax_number": "207-523-8595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMPSON",
        "first_name": "THERESA",
        "middle_name": "A.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-19",
        "last_updated": "2019-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC6842",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "432087899",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THERESA",
            "last_name": "MARTIN",
            "middle_name": "ANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.