Healthcare Provider Details

I. General information

NPI: 1386603363
Provider Name (Legal Business Name): NICOLE PIETRINI RICHMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 STATE ST STE 203
GORHAM ME
04038-1173
US

IV. Provider business mailing address

15 CEDAR LN
RAYMOND ME
04071-6381
US

V. Phone/Fax

Practice location:
  • Phone: 207-839-3535
  • Fax: 207-222-4013
Mailing address:
  • Phone: 207-468-8108
  • Fax: 207-222-4013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC5065
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier413848
Identifier TypeOTHER
Identifier StateME
Identifier IssuerAETNA
# 2
Identifier047034
Identifier TypeOTHER
Identifier StateME
Identifier IssuerANTHEM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: