Active NPI
Colin Mikail Micucci
- Behavior Technician
- South Portland, ME
National Provider Identifier
1508606161
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 3181368
- Practice address
- 50 Donald B Dean Dr
South Portland, ME 04106-3373 - Phone
- (207) 274-2528
- NPI assigned
- May 30, 2024
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 3181368 | ME | Primary |
Addresses
Primary practice location
50 Donald B Dean Dr
South Portland, ME 04106-3373
Mailing address
996 Royal Marco Way
Marco Island, FL 34145-1829
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3181368 | ME | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1717027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717027200000",
"number": "1508606161",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "996 ROYAL MARCO WAY",
"city": "MARCO ISLAND",
"state": "FL",
"postal_code": "341451829"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 DONALD B DEAN DR",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041063373",
"telephone_number": "207-274-2528"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICUCCI",
"first_name": "COLIN",
"middle_name": "MIKAIL",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-05-30",
"last_updated": "2024-05-30",
"certification_date": "2024-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "ME",
"license": "3181368",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.