Kenneth Rautiola, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LC14615 Issued in ME

Practice address

40 Summer St
Bangor, ME 04401-7144

Phone

(207) 945-4240

NPI assigned

Apr 13, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1334275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627948800000",
    "number": "1639436744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 SUMMER ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044017144",
            "telephone_number": "207-945-4240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 SUMMER ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044017144",
            "telephone_number": "207-945-4240"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1066 Kenduskeag Ave",
            "address_purpose": "LOCATION",
            "city": "Bangor",
            "state": "ME",
            "postal_code": "044012914",
            "country_code": "US",
            "telephone_number": "207-299-1944",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAUTIOLA",
        "first_name": "KENNETH",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-13",
        "last_updated": "2021-08-03",
        "certification_date": "2021-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "MC13008",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC14615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Max L Rannie, MD
• Sabita M Rao, DMD
• Taylor Rapaport, LCSW
• Naraharisetty Anita Rau, MD
• Amanda Marie Rautenberg
• Amelia Louise Ravin, FNP-C
• David J Rawcliffe, DO
• John P Raymond, PA-C
• Melissa D Raymond, PT
• Micah Billings Cole Raymond, LCPC-C/ LADC

• Clinical Social Worker in Bangor, ME
• Providers in Bangor, ME by specialty
• Clinical Social Worker in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.