Basic Information
| Provider Information | |||||||||
| NPI: | 1417225046 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BICKFORD | ||||||||
| FirstName: | CARRIE | ||||||||
| MiddleName: | BERNICE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LAKS | ||||||||
| OtherFirstName: | CARRIE | ||||||||
| OtherMiddleName: | B. | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LCSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 166 CEDAR ST | ||||||||
| Address2: | |||||||||
| City: | ROCKLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 048412305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137774683 | ||||||||
| FaxNumber: | 3525440722 | ||||||||
| Practice Location | |||||||||
| Address1: | 166 CEDAR ST | ||||||||
| Address2: | |||||||||
| City: | ROCKLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 048412305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137774683 | ||||||||
| FaxNumber: | 3525440722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2011 | ||||||||
| LastUpdateDate: | 11/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SW6987 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.