Amy H Reynolds, LCSW, LADC, CCS

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LC17205 Issued in ME

Practice address

25 Middle St
Portland, ME 04101-4869

Phone

(207) 756-4455

NPI assigned

Nov 4, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

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 and National Provider Directory roles.

• Alternative Wellness Services

  • Community/Behavioral Health Agency
  • Biddeford, ME
  • NPI 1982046207
  NPD
• Primecare Physician Associates

  • Family Medicine Physician
  • Biddeford, ME
  • NPI 1831150911
  NPD (past)

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

{
    "created_epoch": "1604448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604448000000",
    "number": "1417558792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 OAK RIDGE DR",
            "city": "STANDISH",
            "state": "ME",
            "postal_code": "040846019",
            "telephone_number": "207-756-4455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 MIDDLE ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041014869",
            "telephone_number": "207-756-4455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "AMY",
        "middle_name": "H",
        "name_prefix": "Mrs.",
        "credential": "LCSW, LADC, CCS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-04",
        "last_updated": "2020-11-04",
        "certification_date": "2020-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": "ME",
            "license": "LC17205",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC17205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Joseph Revier, LCSW
• Christina Noel Reville
• Patricia J Rewak, NP
• Thalia Reyes, CRNA
• Leasly Anabelle Reyna
• Gretchen May Reynolds
• Mira Luise Reynolds, MD
• Raymond C Reynolds III, MD
• Jacob Rha, MD, MBA
• Rheumatology Associates

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2020; 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.