Active NPI
Lyle Vintinner, PSY.D.
- Clinical Psychologist
- Portland, ME
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS1866
- Practice address
- 53 Baxter Blvd Ste 3
Portland, ME 04101-1827 - Phone
- (413) 356-5423
- NPI assigned
- Sep 11, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PS1866 | ME | Primary |
Addresses
Primary practice location
53 Baxter Blvd Ste 3
Portland, ME 04101-1827
Mailing address
12 1St St Ste 2
Topsham, ME 04086-1334
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
11 Baxter Blvd
FL 2
Portland, ME 04101-1801
Phone (603) 883-0005
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS1866 | ME | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Counseling Center of Nashua Inc | Clinical | Current | Accepting new patients |
Locations
53 Baxter Blvd
Ste 3
Portland, ME 04101
Phone (207) 613-4115
53 Baxter Blvd
Portland, ME 04101
Phone (207) 245-1648
11 Baxter Blvd
Fl 2
Portland, ME 04101
Phone (207) 306-9900
1 Main St
Nashua, NH 03064
Phone (603) 689-7978
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599782400000",
"number": "1861007387",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 1ST ST STE 2",
"city": "TOPSHAM",
"state": "ME",
"postal_code": "040861334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "53 BAXTER BLVD STE 3",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041011827",
"telephone_number": "413-356-5423"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VINTINNER",
"first_name": "LYLE",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-09-11",
"last_updated": "2020-09-11",
"certification_date": "2020-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "ME",
"license": "PS1866",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2020; 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.