Kaycee Theberge, LMSW-CC

Primary specialty

Social WorkerTaxonomy code 104100000X

License

MC15501 Issued in ME

Practice address

901 Washington Ave
Portland, ME 04103-2737

Phone

(207) 871-1211

NPI assigned

Sep 25, 2015

Last updated

Sep 25, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Crossroads for Women, Inc.

  dba Crossroads

  • Addiction (Substance Use Disorder) Counselor
  • Scarborough, ME
  • NPI 1326030701
  NPD

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

{
    "created_epoch": "1443139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443139200000",
    "number": "1407226079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 WASHINGTON AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041032737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 WASHINGTON AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041032737",
            "telephone_number": "207-871-1211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEBERGE",
        "first_name": "KAYCEE",
        "credential": "LMSW-CC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-25",
        "last_updated": "2015-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ME",
            "license": "MC15501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Samaritan Care LLC (Personal Care Agency)
• The Sports Therapy Center LLC
• The Training Room, Inc.
• The Weight Loss & Diabetes Center, LLC (The Weight Loss & Diabetes Center)
• Thea Skydel Wellness, LLC
• Matthew A Thees, OD
• Tamer George I Theodory, DDS
• Therapeutic Space With Lara
• Cam L Theriault, LSW-C
• Denise M Theriault, D.M.D.

• Social Worker in Portland, ME
• Providers in Portland, ME by specialty
• Social Worker in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.