DR. JERROLD C. EDELBERG (NPI# 1619203973) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619203973 |
| Entity Type | Individual |
| Full Name | DR. JERROLD C. EDELBERG |
| Credential | PH.D. |
| Practice Address |
280b Gannett Dr South Portland ME 04106-6940 |
| Practice Telephone | 2078280048 |
| Practice Fax Number | 2077723743 |
| Mailing Telephone | 2078280048 |
| Mailing Fax Number | 2077723743 |
| Enumeration Date | 2009-10-21 |
| Last Update Date | 2013-11-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
PS561 | ME | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ME | 1053467779 | 05 |
| Street Address |
280B GANNETT DR |
| City | SOUTH PORTLAND |
| State | ME |
| Zip Code | 04106-6940 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053467779 | Port Resources | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 280b Gannett Dr, South Portland, ME 04106-6940 | 2007-01-26 |
| 1053891218 | Michael Pepin | Counselor | 280b Gannett Dr, South Portland, ME 04106-6940 | 2018-08-17 |
| 1134664287 | Jamie Rose | Counselor | 280b Gannett Dr, South Portland, ME 04106-6940 | 2016-12-28 |
| 1518415579 | Frances Noland Ryan | Social Worker | 280b Gannett Dr, South Portland, ME 04106-6940 | 2016-09-19 |
| 1902351372 | Nicole Labonte | Social Worker | 280b Gannett Dr, South Portland, ME 04106-6940 | 2016-08-16 |
| 1912372830 | Robin Sherman | Social Worker | 280b Gannett Dr, South Portland, ME 04106-6940 | 2015-12-03 |
| 1568834281 | Jamie L Jandreau | Social Worker | 280b Gannett Dr, South Portland, ME 04106-6940 | 2015-10-21 |
| 1376945469 | Elizabeth Dunn | Counselor | 280b Gannett Dr, South Portland, ME 04106-6940 | 2014-09-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912513748 | Rayna Louise Sage | Behavior Technician | 50 Donald Beaver Drrive, Ste B, Portland, ME 04106 | 2020-09-17 |
| 1972127330 | Scott M Davis Md LLC | Internal Medicine | 89 Cannon Road, South Portland, ME 04106 | 2020-06-02 |
| 1568013936 | Clara Cassidy | Behavior Technician | 50 Donald Bean Dr, Ste B, South Portland, ME 04106 | 2019-09-26 |
| 1336614346 | Kari Whitney | Nurse Practitioner | Vna Home Health Hospice, 50 Foden Road, Suite 1, South Portland, ME 04106 | 2018-10-05 |
| 1588152193 | Kristen F. Pierce | Counselor | 100 Waterman Drive, Suite 201, South Portland, ME 04106 | 2018-04-30 |
| 1649779224 | Jennifer Rene Johnson | Social Worker | 135 Westbrook St, South Portland, ME 04106 | 2018-02-08 |
| 1154847721 | Integral Nutrition, LLC | Dietitian, Registered | 59 Baltimore Avenue, South Portland, ME 04106 | 2017-08-16 |
| 1730619610 | John Preston Powell | Psychiatry & Neurology | 68 B Street Apt 4, South Portland, ME 04106 | 2017-06-14 |
| 1649706268 | Gisselle Mani | Student in an Organized Health Care Education/Training Program | 30 Lydia Ln Apt 2115, South Portland, ME 04106 | 2017-05-02 |
| 1245786987 | Jonathan Frank Olmes | Optometrist | 335 Maine Mall Rd., South Portland, ME 04106 | 2016-09-01 |
| Find all providers in zip 04106 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205858180 | Lee Katherine Nicoloff | Psychologist | 884 Broadway, South Portland, ME 04106-4371 | 2006-07-23 |
| 1831169259 | James M Claiborn | Psychologist | 6 D St, South Portland, ME 04106-2820 | 2006-01-26 |
| 1962850321 | Erin Hatch | Psychologist | 119 Gannett Dr, South Portland, ME 04106-6942 | 2016-05-26 |
| 1952774051 | Erin E. Hatch, Psy.d. | Psychologist | 119 Gannett Dr, South Portland, ME 04106-6942 | 2015-11-11 |
| 1811246010 | Hannah Taylor | Psychologist | 100 Foden Rd, #103, South Portland, ME 04106-2327 | 2012-09-04 |
| 1467588608 | Louise A. Zubrod | Psychologist | 345 Cottage Rd, South Portland, ME 04106 | 2007-02-24 |
| 1710027099 | Peter Flavin Donnelly | Psychologist | 6 D St, South Portland, ME 04106-2820 | 2007-02-07 |
| 1922187202 | James F Whelan | Psychologist | 341 Pine St, South Portland, ME 04106-3842 | 2006-11-06 |
| 1689781247 | David C. Nichols | Psychologist | 345 Cottage Rd, South Portland, ME 04106-3919 | 2006-08-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861007387 | Lyle Vintinner | Psychologist | 53 Baxter Blvd Ste 3, Portland, ME 04101-1827 | 2020-09-11 |
| 1720696586 | Sound Mind Psychology LLC | Psychologist | 110 Main St Ste 1201b, Saco, ME 04072-3516 | 2020-07-17 |
| 1134769391 | Lagom Psychology, Pllc | Psychologist | 106 Lafayette St Ste 2b, Yarmouth, ME 04096-6125 | 2020-01-15 |
| 1952942559 | Andrea J Medaris | Psychologist | 153 Park Row Ste 302, Brunswick, ME 04011-2053 | 2019-10-04 |
| 1528539335 | Mark G Kiefner Phd LLC | Psychologist | 225 Commercial St Ste 403, Portland, ME 04101-6603 | 2018-12-06 |
| 1841785680 | Joseph Michael Graziadei | Psychologist | 21 Poolside Ln, Biddeford, ME 04005-9466 | 2018-06-25 |
| 1548770332 | Amanda Seirup | Psychologist | 16 Lincoln St Ste C, Brunswick, ME 04011-1900 | 2017-10-05 |
| 1942743679 | Medoptions of Maine, LLC | Psychologist | 45 Memorial Cir, Augusta, ME 04330-6400 | 2016-11-29 |
| 1578019113 | Lydia Ward-gray, Psyd, LLC | Psychologist | 19 South Street, Suite 4, Portland, ME 04101 | 2016-09-01 |
| 1942652656 | Nancy Slobodnik | Psychologist | 1 Va Ctr # 28, Augusta, ME 04330-6719 | 2016-07-06 |
| Find all providers with the same taxonomy | ||||
| City | SOUTH PORTLAND |
| Zip Code | 04106 |
Please comment or provide details below to improve the information on DR. JERROLD C. EDELBERG.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.