Timothy M Ericson, LCSW, LADC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LC2045 Issued in ME

Practice address

4 Dane St
Kennebunk, ME 04043-7054

Phone

(207) 985-4211

NPI assigned

Jul 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Specialty

Clinical Social Worker

Education

Other, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Tim Ericson, LLC

  • Clinical Social Worker
  • Kennebunk, ME
  • NPI 1578132569
  Medicare reassignment NPD Authorized official
• Sweetser

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Saco, ME
  • NPI 1538122445
  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316563200000",
    "number": "1720006943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 PARKER ST",
            "city": "NEWBURYPORT",
            "state": "MA",
            "postal_code": "019504033",
            "telephone_number": "207-985-4211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 DANE ST",
            "city": "KENNEBUNK",
            "state": "ME",
            "postal_code": "040437054",
            "telephone_number": "207-985-4211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERICSON",
        "first_name": "TIMOTHY",
        "middle_name": "M",
        "credential": "LCSW, LADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2011-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "ME",
            "license": "LC683",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC2045",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "007005",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephanie Einsiedler, SLP
• Elevate Speech and Myofunctional Therapy PLLC
• Eliza LLC
• Joan S Elkins, M.D.
• Katelyn Ellison, PT
• Brian Randall Ewy, DO
• Faldman Chiropractic Center
• Clifford Lewis Faldman, D.C.
• Family Chiropractic of Kennebunk, PA
• Kristin M Farrand, FNP

• Clinical Social Worker in Kennebunk, ME
• Providers in Kennebunk, 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 Sep 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.