Healthcare Provider Details

I. General information

NPI: 1285619452
Provider Name (Legal Business Name): PHILIP K. PIERCE M.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2005
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CHURCH ST
LACONIA NH
03246-3432
US

IV. Provider business mailing address

111 CHURCH ST
LACONIA NH
03246-3432
US

V. Phone/Fax

Practice location:
  • Phone: 603-524-1100
  • Fax:
Mailing address:
  • Phone: 603-524-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDP00297
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01318
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: