Provider Demographics
NPI:1396970703
Name:PIERCE, CARRIE J (MA)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:J
Last Name:PIERCE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:33C LEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-1025
Mailing Address - Country:US
Mailing Address - Phone:866-905-4483
Mailing Address - Fax:207-862-2029
Practice Address - Street 1:33C LEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:HAMPDEN
Practice Address - State:ME
Practice Address - Zip Code:04444-1025
Practice Address - Country:US
Practice Address - Phone:866-905-4483
Practice Address - Fax:207-862-2029
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431784900Medicaid
ME30973OtherCDS