Individual provider Active NPI

Lyle Vintinner, PSY.D.

  • Clinical Psychologist
  • Portland, ME
National Provider Identifier
1861007387
Registry record updated Sep 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PS1866 Issued in ME
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

Updated by the provider on Sep 11, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230830003381 ME Practitioner - Clinical Psychologist 2961865407 Reassigns benefits to 1 organization

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
The Counseling Center of Nashua IncGroup PAC ID 3274523758, 250 clinicians

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

LicenseStateTypeSpecialty
PS1866MEMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
The Counseling Center of Nashua Inc Clinical CurrentSince Jul 17, 2023 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

Verify at the official NPI Registry.