Healthcare Provider Details

I. General information

NPI: 1447641105
Provider Name (Legal Business Name): DYLAN PIERROTTI LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 ORCHARD RD
STANDISH ME
04084-6418
US

IV. Provider business mailing address

1298 CAPE RD
LIMINGTON ME
04049-3215
US

V. Phone/Fax

Practice location:
  • Phone: 207-929-0665
  • Fax:
Mailing address:
  • Phone: 207-929-0665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC5377
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberXL4426
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC4955
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: