Psychmaine LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

PSYCHMAINE LLC

Practice address

550 Forest Ave Ste 103
Portland, ME 04101-1505

Phone

(207) 221-0635

Fax

(207) 221-0634

NPI assigned

Jan 11, 2023

Organization subpart

No

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

Authorized official

Name

Jonathan C Fellers, MDNPI 1508091281

Title

Psychiatrist

Phone

(207) 221-0635

Specialties & licenses 9

Addresses

Other names 1

• PsychMaine Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jonathan Carl Fellers, MD

  • Addiction Psychiatry Physician
  • Portland, ME
  • NPI 1508091281

  Addiction Medicine

  NPD (past) Authorized official
• Naomi J Davis, LCPC-C

  • Mental Health Counselor
  • Portland, ME
  • NPI 1992419964
  NPD

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

{
    "created_epoch": "1673395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677628800000",
    "number": "1891409025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 FOREST AVE STE 103",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041011505",
            "telephone_number": "207-221-0635",
            "fax_number": "207-221-0634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 FOREST AVE STE 103",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041011505",
            "telephone_number": "207-221-0635",
            "fax_number": "207-221-0634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHMAINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-11",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A",
        "authorized_official_last_name": "FELLERS",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PSYCHIATRIST",
        "authorized_official_telephone_number": "207-221-0635",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2083A0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PsychMaine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PsychMaine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Promptcare New England Respiratory
• Gilda J Pronych, DDS
• Georgana Prudhomme, LCSW
• Rodger M. Pryzant, M.D.
• Psychiatric Associates
• Psychodiagnostic Services of Southern Maine
• Paul Puchalski, LCSW
• Theresa Puckett
• Claire Zollman Puffer, PA-C
• Leah Puffer, RN

• Multi-Specialty Clinic/Center in Portland, ME
• Providers in Portland, ME by specialty
• Multi-Specialty Clinic/Center in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.