Active NPI
Tina K Beverly, LMSW-CC
- Social Worker
- Newport, ME
National Provider Identifier
1659726172
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- MC15885
- Practice address
- 442 Moosehead TRL
Newport, ME 04953-4004 - Phone
- (207) 907-7205
- Fax
- (207) 561-4725
- NPI assigned
- May 3, 2016
- Last updated
- May 3, 2016
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | MC15885 | ME | Primary |
Addresses
Primary practice location
442 Moosehead TRL
Newport, ME 04953-4004
Mailing address
29 Franklin St
Bangor, ME 04401-4909
Phone (207) 907-7205
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| IN PROCESS | Medicaid | ME |
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 |
|---|---|---|---|
| MC15885 | ME | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northeast Occupational Exchange, Inc | Social Worker | Past | Accepting new patients |
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, 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": "1462233600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1462233600000",
"number": "1659726172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29 FRANKLIN ST",
"city": "BANGOR",
"state": "ME",
"postal_code": "044014909",
"telephone_number": "207-907-7205",
"fax_number": "207-561-4725"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "442 MOOSEHEAD TRL",
"city": "NEWPORT",
"state": "ME",
"postal_code": "049534004",
"telephone_number": "207-907-7205",
"fax_number": "207-561-4725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEVERLY",
"first_name": "TINA",
"middle_name": "K",
"credential": "LMSW-CC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-05-03",
"last_updated": "2016-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "ME",
"license": "MC15885",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "IN PROCESS",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newport, ME
- Steven J Badeen, MD
- John C Baker, MD
- Bay View Physical Therapy Limited Partnership (Bay View Physical Therapy of Newport)
- Bay View Physical Therapy Limited Partnership
- Catharine E Bennett, RN
- Emily Boyd
- Alyssa Lynn Bragdon, MS OTR/L
- Cynthia E Breare, LCPC-C
- Linda R Bright, LCSW
- Kraig Michael Burbine, RN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.