Provider Demographics
NPI:1639209604
Name:CHARPENTIER, MIA MICHELE (MA)
Entity type:Individual
Prefix:MRS
First Name:MIA
Middle Name:MICHELE
Last Name:CHARPENTIER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MONUMENT SQ STE 200
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-6188
Mailing Address - Country:US
Mailing Address - Phone:978-353-9057
Mailing Address - Fax:
Practice Address - Street 1:15 MONUMENT SQ STE 200
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-6188
Practice Address - Country:US
Practice Address - Phone:978-353-9057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health