| Tim Ericson, Llc | |
|
62 Portland Rd Kennebunk ME 04043-6658 | |
| (207) 985-4211 | |
| Not Available |
| Full Name | Tim Ericson, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 62 Portland Rd, Kennebunk, Maine |
| Authorized Official Name and Position | Timothy M. Ericson (SOCIAL WORKER) |
| Authorized Official Contact | 2079854211 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tim Ericson, Llc 62 Portland Rd Kennebunk ME 04043-6658 Ph: (207) 985-4211 | Tim Ericson, Llc 62 Portland Rd Kennebunk ME 04043-6658 Ph: (207) 985-4211 |
| NPI Number | 1578132569 |
|---|---|
| Provider Enumeration Date | 06/23/2021 |
| Last Update Date | 06/23/2021 |
| Certification Date | 06/23/2021 |
| Medicare PECOS PAC ID | 1951707462 |
|---|---|
| Medicare Enrollment ID | O20210909000268 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578132569 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Timothy M Ericson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720006943 PECOS PAC ID: 4082629316 Enrollment ID: I20060208000250 |
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