Basic Information
| Provider Information | |||||||||
| NPI: | 1073809034 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERCE | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW, CADC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DIONNE | ||||||||
| OtherFirstName: | HEATHER | ||||||||
| OtherMiddleName: | A | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 180 ACADEMY ST STE 3 | ||||||||
| Address2: | |||||||||
| City: | PRESQUE ISLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047693183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075542352 | ||||||||
| FaxNumber: | 2075542351 | ||||||||
| Practice Location | |||||||||
| Address1: | 88 FOX ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MADAWASKA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077286341 | ||||||||
| FaxNumber: | 2077287762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2011 | ||||||||
| LastUpdateDate: | 02/02/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LC16956 | ME | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101Y00000X | CAC5411 | ME | N | Behavioral Health & Social Service Providers | Counselor |
No ID Information.