Megan C. Boothby, LCSW – Clinical Social Worker

Key facts

NPI: 1790098960
Entity type: Individual (NPI type 1)
Primary specialty: Clinical Social Worker 1041C0700X
License: LC13935 (ME)
Practice address: 222 Saint John St Ste 213
Portland, ME 04102-3063
Phone: (207) 370-1238
Fax: (207) 835-0009
NPI assigned: Jul 16, 2010
Sex: Female
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file
Eligible to order & refer: Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

National Provider Directory

Medicare enrollment (NPD): Yes

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Clinical Social Worker	1041C0700X	LC13935	ME	Yes

Addresses

Primary practice location

222 Saint John St Ste 213
Portland, ME 04102-3063

Mailing address

222 Saint John St Ste 213
Portland, ME 04102-3063
Phone (207) 370-1238

Other identifiers

Identifier	Type	State	Issuer
436317199	Medicaid	ME

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 19, 2021.

{
    "created_epoch": "1279238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1790098960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 SAINT JOHN ST STE 213",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023063",
            "telephone_number": "207-370-1238",
            "fax_number": "207-842-7773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 SAINT JOHN ST STE 213",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023063",
            "telephone_number": "207-370-1238",
            "fax_number": "207-835-0009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOTHBY",
        "first_name": "MEGAN",
        "middle_name": "C.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-16",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC13935",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "436317199",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

All providers in Portland, ME · Clinical Social Worker in Maine

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 19, 2021. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.