Provider Demographics
NPI:1538264809
Name:PIERCE, PHILIP SARGENT (PHD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:SARGENT
Last Name:PIERCE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:79 WAITES LANDING ROAD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1939
Mailing Address - Country:US
Mailing Address - Phone:207-781-3769
Mailing Address - Fax:
Practice Address - Street 1:TOGUS VAMC
Practice Address - Street 2:PSYCHOLOGY 116B
Practice Address - City:TOGUS
Practice Address - State:ME
Practice Address - Zip Code:04330-9929
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:207-623-5791
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEPS173103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical