East Coast Wellness LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

EAST COAST WELLNESS LLC

Practice address

553 Shore Rd Ste 2
Cape Elizabeth, ME 04107-1010

Phone

(207) 400-5876

NPI assigned

Oct 29, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Loren Bush, PSYDNPI 1437539210

Title

Clinical Psychologist

Phone

(207) 400-5092

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ME

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Loren Bush, PSY.D.

  • Clinical Psychologist
  • Portland, ME
  • NPI 1437539210
  Medicare reassignment Care Compare group NPD Authorized official
• Quynn Wiscombe Morehouse, PSYD

  • Clinical Psychologist
  • Cape Elizabeth, ME
  • NPI 1982074373
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1540771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631491200000",
    "number": "1447727466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "553 SHORE RD STE 2",
            "city": "CAPE ELIZABETH",
            "state": "ME",
            "postal_code": "041071010",
            "telephone_number": "207-400-5876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "553 SHORE RD STE 2",
            "city": "CAPE ELIZABETH",
            "state": "ME",
            "postal_code": "041071010",
            "telephone_number": "207-400-5876"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "205 Ocean Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "ME",
            "postal_code": "041035712",
            "country_code": "US",
            "telephone_number": "207-773-7993 x13",
            "fax_number": "207-773-5512",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EAST COAST WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-29",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-13",
        "status": "A",
        "authorized_official_last_name": "BUSH",
        "authorized_official_first_name": "LOREN",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "207-400-5092",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "E300280666",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "E300279945",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ava Rebekah Demer, OTR/L
• Victoria M Dibbins, PT
• Johanna Dicianni, PT
• Mark David Dickinson, DDS
• Travis Dixon
• Julie Ewald, M.A./O.T.R.L.
• Excellent Residential Care LLC
• Marita Fichera, FNP-BC
• Jennifer-Lynn Flynn, NP
• Stephanie Fortier

• Clinical Psychologist in Cape Elizabeth, ME
• Providers in Cape Elizabeth, ME by specialty
• Clinical Psychologist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.