1417225046 NPI number — MS. CARRIE BERNICE BICKFORD LCSW

Table of content: DR. ANGELA JOAN RUBINEAU MD (NPI 1467414490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417225046 NPI number — MS. CARRIE BERNICE BICKFORD LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BICKFORD
Provider First Name:
CARRIE
Provider Middle Name:
BERNICE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAKS
Provider Other First Name:
CARRIE
Provider Other Middle Name:
B.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417225046
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
166 CEDAR ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04841-2305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-777-4683
Provider Business Mailing Address Fax Number:
352-544-0722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
166 CEDAR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04841-2305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-777-4683
Provider Business Practice Location Address Fax Number:
352-544-0722
Provider Enumeration Date:
12/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW6987 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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