Andrea J Medaris, PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PS1596 Issued in ME

Practice address

153 Park Row Ste 302
Brunswick, ME 04011-2053

Phone

(207) 358-9607

NPI assigned

Oct 4, 2019

Last updated

Oct 4, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 1, 2024 through Feb 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dragonfly Psychological Services LLC

  • Clinical Psychologist
  • Topsham, ME
  • NPI 1437753290
  NPD Authorized official
• Psychology Specialists of Maine

  • Counseling Psychologist
  • Brunswick, ME
  • NPI 1326571241
  NPD (past)

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

{
    "created_epoch": "1570147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570147200000",
    "number": "1952942559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "153 PARK ROW STE 302",
            "city": "BRUNSWICK",
            "state": "ME",
            "postal_code": "040112053",
            "telephone_number": "207-358-9607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 PARK ROW STE 302",
            "city": "BRUNSWICK",
            "state": "ME",
            "postal_code": "040112053",
            "telephone_number": "207-358-9607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDARIS",
        "first_name": "ANDREA",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-04",
        "last_updated": "2019-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ME",
            "license": "PS1596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael McNally, DPM
• Tammy McNally, RDH
• Jessica McNaughton
• Patti Rae McTigue, OTR/L
• Matthew A Mechtenberg, D.O.
• Megan Angelos Counseling LLC
• Brian M Meldrum, LCPC
• Jessica Mellon, LCPC
• Britney Noella Merrill, LMSW-CC
• Merrymeeting Behavioral Health Associates

• Clinical Psychologist in Brunswick, ME
• Providers in Brunswick, ME by specialty
• Clinical Psychologist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.