Individual provider Active NPI

Christine R Bergeron, LCSW

  • Counselor
  • Portland, ME
National Provider Identifier
1982238580
Registry record updated Jan 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Practice address
53 Baxter Blvd Ste 3
Portland, ME 04101-1827
Phone
(603) 689-6562
NPI assigned
Feb 24, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LC23162 ME
Counselor 101Y00000X Primary

Addresses

Primary practice location

53 Baxter Blvd Ste 3
Portland, ME 04101-1827

Mailing address

PO Box 568
Kennebunkport, ME 04046-0568
Phone (603) 689-6562

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
I20240207002865 ME Practitioner - Clinical Social Worker 3678916541 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Boston University School of Medicine, 2020
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)

53 Baxter Blvd
Portland, ME 04101-1827
Phone (603) 883-0005

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LC23162MEMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
The Counseling Center of Nashua Inc Clinical CurrentSince Jan 2, 2024 Accepting new patients

Locations

53 Baxter Blvd
Ste 3
Portland, ME 04101
Phone (207) 613-4115

11 Baxter Blvd
Fl 2
Portland, ME 04101
Phone (207) 306-9900

53 Baxter Blvd
Portland, ME 04101
Phone (207) 245-1648

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": "1582502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1982238580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 568",
            "city": "KENNEBUNKPORT",
            "state": "ME",
            "postal_code": "040460568",
            "telephone_number": "603-689-6562"
        },
        {
            "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": "603-689-6562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGERON",
        "first_name": "CHRISTINE",
        "middle_name": "R",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-24",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC23162",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.