Provider Demographics
NPI:1447641105
Name:PIERROTTI, DYLAN (LCPC)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:PIERROTTI
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1298 CAPE RD
Mailing Address - Street 2:
Mailing Address - City:LIMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04049-3215
Mailing Address - Country:US
Mailing Address - Phone:207-929-0665
Mailing Address - Fax:
Practice Address - Street 1:5 ORCHARD RD
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:ME
Practice Address - Zip Code:04084-6418
Practice Address - Country:US
Practice Address - Phone:207-929-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC5377101YA0400X
MEXL4426101YM0800X
MECC4955101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1447641105Medicaid