Individual provider Active NPI

Jennifer L Spain, LCSW

  • Clinical Social Worker
  • Bangor, ME
National Provider Identifier
1972835536
Registry record updated May 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LC15106 Issued in ME
Practice address
1068 Union St
Bangor, ME 04401-3016
Phone
(207) 404-8181
Fax
(207) 922-4198
NPI assigned
Feb 8, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LC15106 ME Primary

Addresses

Primary practice location

1068 Union St
Bangor, ME 04401-3016

Mailing address

PO Box 1599
Bangor, ME 04402-1599
Phone (207) 404-8200

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
I20150509000253 ME Practitioner - Clinical Social Worker 7214256452 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Penobscot Community Health CenterGroup PAC ID 0143212670, 135 clinicians

Practice addresses (Care Compare)

1068 Union St
Bangor, ME 04401-3016
Phone (207) 404-8181

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LC15106MEMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Acadia Hospital Corp CurrentSince Dec 1, 2014 Accepting new patients
McKay Counseling PLLC CurrentSince Dec 1, 2020 Accepting new patients
Penobscot Community Health Center CurrentSince Oct 1, 2020 Accepting new patients
Penobscot Community Health Center CurrentSince Oct 1, 2020 Accepting new patients

Locations

1068 Union St
Bangor, ME 04401
Phone (207) 404-8181

268 Stillwater Ave
Bangor, ME 04401
Phone (207) 973-6470

1012 Union St
Ste 1
Bangor, ME 04401
Phone 2079455247407

235 Center St
Brewer, ME 04412
Phone (207) 299-5157

Organizations & group practices 4

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": "1265587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620172800000",
    "number": "1972835536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1599",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044021599",
            "telephone_number": "207-404-8200",
            "fax_number": "207-947-0435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1068 UNION ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013016",
            "telephone_number": "207-404-8181",
            "fax_number": "207-922-4198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPAIN",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-08",
        "last_updated": "2021-05-05",
        "certification_date": "2021-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC15106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.