NPIMap

Organization Active NPI

Stonycreek Psychotherapy and Wellness LLC

  • Professional Counselor
  • Portland, ME
National Provider Identifier
1922612936
Registry record updated Sep 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
STONYCREEK PSYCHOTHERAPY AND WELLNESS LLC
Practice address
52 Cove St
Portland, ME 04101-2514
Phone
(207) 400-5296
NPI assigned
Sep 8, 2020
Organization subpart
No

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

Authorized official

Name
Laura WattersNPI 1033534557
Title
Owner
Phone
(207) 956-5977

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X Primary

Addresses

Primary practice location

52 Cove St
Portland, ME 04101-2514

Mailing address

52 Cove St
Portland, ME 04101-2514
Phone (207) 956-5977

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME, NH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240131004135 ME Part B Supplier - Clinic/Group Practice 4688027170 Receives reassigned benefits from 5 practitioners
Practice locations: Bangor, ME; Falmouth, ME; South Portland, ME
O20250527000126 NH Part B Supplier - Clinic/Group Practice 4688027170 Receives reassigned benefits from 3 practitioners
Practice locations: Salem, NH

National Provider Directory

National Provider Directory

Locations

108 State St
Ste 3
Bangor, ME 04401
Phone (207) 956-5977

1 Constellation Way
Ste 101
Falmouth, ME 04105
Phone (207) 707-5177

260 Western Ave
Ste 202
South Portland, ME 04106
Phone (207) 956-5977

260 Western Ave
Ste 204
South Portland, ME 04106
Phone (207) 956-5977

202 Main St
Ste 103
Salem, NH 03079
Phone (207) 956-5977

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1599523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599782400000",
    "number": "1922612936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52 COVE ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041012514",
            "telephone_number": "207-956-5977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52 COVE ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041012514",
            "telephone_number": "207-400-5296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONYCREEK PSYCHOTHERAPY AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-08",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A",
        "authorized_official_last_name": "WATTERS",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "207-956-5977"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.