Individual provider Active NPI

Jaime Mastrorio, LCSW

  • Clinical Social Worker
  • Portland, ME
National Provider Identifier
1679083604
Registry record updated Jul 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LC18378 Issued in ME
Practice address
32 Clark St
Portland, ME 04102-4100
Phone
(508) 243-3580
Fax
(207) 878-2259
NPI assigned
Oct 4, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 4, 2022

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 LC18378 ME Primary

Addresses

Primary practice location

32 Clark St
Portland, ME 04102-4100

Mailing address

32 Clark St Apt B
Portland, ME 04102-4112
Phone (508) 243-3580

Other identifiers 2

IdentifierTypeStateIssuer
MC16717OtherMELICENSE MAINE
LC18378OtherMELICENSE MAINE

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
I20201123000735 ME Practitioner - Clinical Social Worker 5890106942

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1507075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656892800000",
    "number": "1679083604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 CLARK ST APT B",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041024112",
            "telephone_number": "508-243-3580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 CLARK ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041024100",
            "telephone_number": "508-243-3580",
            "fax_number": "207-878-2259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASTRORIO",
        "first_name": "JAIME",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-10-04",
        "last_updated": "2022-07-04",
        "certification_date": "2022-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC18378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE MAINE",
            "identifier": "MC16717",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE MAINE",
            "identifier": "LC18378",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.