Katie L. Vine, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

120568 Issued in NY

Practice address

130 Arizona Ave
Plattsburgh, NY 12903-4908

Phone

(518) 565-4060

NPI assigned

Aug 10, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Catholic Charities Maine

  • Clinical Social Worker
  • Portland, ME
  • NPI 1013955947

  Clinical, ME

  Medicare reassignment NPD
• Clinton County

  • Mental Health Counselor
  • Plattsburgh, NY
  • NPI 1164465902
  NPD (past)
• Catholic Charities Maine

  • Community/Behavioral Health Agency
  • Portland, ME
  • NPI 1487020970
  NPD (past)

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

{
    "created_epoch": "1344556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691452800000",
    "number": "1992052773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37 PEMBROKE ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041035112",
            "telephone_number": "207-956-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 ARIZONA AVE",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129034908",
            "telephone_number": "518-565-4060"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11 Baxter Blvd",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "ME",
            "postal_code": "041011801",
            "country_code": "US",
            "telephone_number": "207-775-5671",
            "fax_number": "207-871-1243",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "131 Ocean St",
            "address_purpose": "LOCATION",
            "city": "South Portland",
            "state": "ME",
            "postal_code": "041063649",
            "country_code": "US",
            "telephone_number": "207-261-0231",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VINE",
        "first_name": "KATIE",
        "middle_name": "L.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-10",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC15400",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "120568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Ann Vicencio, ATC
• Victor Ludewig MD PC
• Benjamin F Vilbert, MD
• James Vincent, RPH
• Krrynne Apprille Vincent, FNP-BC
• Viqar Qudsi,MD
• Steven Joseph Vogl, MA, CCC-SLP
• Charles Philip Volk, MD
• CHI Kim Vu, D.D.S.
• Rajiv Pradeep Vyas, MD

• All providers in Plattsburgh, NY
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.