Kimberly Austin, LCSW
Individual provider Active NPI Social Worker · Portland, ME
NPI 1588677603 · NPPES record last updated Apr 23, 2013
Key facts
- NPI
- 1588677603
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- LC10159 (ME)
- Practice address
- 343 Forest Ave
Portland, ME 04101-2006 - Phone
- (207) 874-1030
- Fax
- (207) 874-1044
- NPI assigned
- Aug 14, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2024 through Jul 1, 2028
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC10159 | ME | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kim Austin Associates, LLC | Current |
Accepting new patients | |
| Maine Behavioral Healthcare | Past | Accepting new patients |
Locations
520 W Ponce de Leon Ave
#99
Decatur, GA 30030
Phone (207) 295-7427
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | LC10159 | ME | |
| Mental Health Counselor | 101YM0800X | LC10159 | ME | |
| Social Worker | 104100000X | LC10159 | ME | Yes |
| Marriage & Family Therapist | 106H00000X | LC10159 | ME |
Addresses
Primary practice location
343 Forest Ave
Portland, ME 04101-2006
Mailing address
343 Forest Ave
Portland, ME 04101-2006
Phone (207) 874-1030
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 104760100 | Medicaid | ME |
Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 23, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.