Individual provider Active NPI

Kristina M Bissell, LCSW

  • Clinical Social Worker
  • Bangor, ME
National Provider Identifier
1558396226
Registry record updated May 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LC10230 Issued in ME
Practice address
992 Union St
Bangor, ME 04401-3057
Phone
(207) 992-2601
Fax
(207) 404-8351
NPI assigned
Jul 11, 2006
Last updated
May 4, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2021

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 LC10230 ME Primary

Addresses

Primary practice location

992 Union St
Bangor, ME 04401-3057

Mailing address

PO Box 1599
Bangor, ME 04402-1599
Phone (207) 992-2601

Other names 1

  • Kristina M McCorrison Other 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
I20060930000049 ME Practitioner - Clinical Social Worker 2567467277 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Acadia Hospital Corp CurrentSince Aug 16, 2009 Accepting new patients
Penobscot Community Health Center Past Accepting new patients
Penobscot Community Health Center Past Accepting new patients
Acadia Healthcare, Inc Past Accepting new patients

Locations

268 Stillwater Ave
Bangor, ME 04401
Phone (207) 973-6470

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620086400000",
    "number": "1558396226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1599",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044021599",
            "telephone_number": "207-992-2601",
            "fax_number": "207-404-8351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "992 UNION ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013057",
            "telephone_number": "207-992-2601",
            "fax_number": "207-404-8351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BISSELL",
        "first_name": "KRISTINA",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-11",
        "last_updated": "2021-05-04",
        "certification_date": "2021-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC10230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTINA",
            "last_name": "MCCORRISON",
            "middle_name": "M",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.