Basic Information
| Provider Information | |||||||||
| NPI: | 1275017931 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIERCE | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | EVAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 96 SOUTH ST | ||||||||
| Address2: | |||||||||
| City: | WARE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010821616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4139676241 | ||||||||
| FaxNumber: | 4139679807 | ||||||||
| Practice Location | |||||||||
| Address1: | 96 SOUTH ST | ||||||||
| Address2: | |||||||||
| City: | WARE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010821616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4139676241 | ||||||||
| FaxNumber: | 4139679807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2018 | ||||||||
| LastUpdateDate: | 09/19/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.