Individual provider Active NPI

Kalyn Elise Burgio, LCSW

  • Clinical Social Worker
  • Portland, ME
National Provider Identifier
1629750591
Registry record updated Aug 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LC22651 Issued in ME
Practice address
11 Baxter Blvd FL 2
Portland, ME 04101-1801
Phone
(603) 883-0005
NPI assigned
Aug 1, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 1, 2023

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 LC22651 ME Primary

Addresses

Primary practice location

11 Baxter Blvd FL 2
Portland, ME 04101-1801

Mailing address

11 Baxter Blvd FL 2
Portland, ME 04101-1801
Phone (603) 883-0005

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
I20231026003087 ME Practitioner - Clinical Social Worker 4688020647 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
University of Alabama School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Counseling Center of Nashua IncGroup PAC ID 3274523758, 250 clinicians

Practice addresses (Care Compare)

11 Baxter Blvd
FL 2
Portland, ME 04101-1801
Phone (603) 883-0005

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LC22651MEMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
The Counseling Center of Nashua Inc Clinical CurrentSince Sep 1, 2023 Accepting new patients

Locations

53 Baxter Blvd
Ste 3
Portland, ME 04101
Phone (207) 613-4115

11 Baxter Blvd
Fl 2
Portland, ME 04101
Phone (207) 306-9900

53 Baxter Blvd
Portland, ME 04101
Phone (207) 245-1648

1 Main St
Nashua, NH 03064
Phone (603) 689-7978

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1690848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690848000000",
    "number": "1629750591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 BAXTER BLVD FL 2",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041011801",
            "telephone_number": "603-883-0005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 BAXTER BLVD FL 2",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041011801",
            "telephone_number": "603-883-0005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGIO",
        "first_name": "KALYN",
        "middle_name": "ELISE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-08-01",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC22651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.