Provider Demographics
NPI:1093962243
Name:TRICKETT, CAROLE WALKER (MSW)
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:WALKER
Last Name:TRICKETT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 PERHAM ST
Mailing Address - Street 2:P.O. BOX 42
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-1523
Mailing Address - Country:US
Mailing Address - Phone:207-778-4329
Mailing Address - Fax:
Practice Address - Street 1:162 PERHAM ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-1523
Practice Address - Country:US
Practice Address - Phone:207-778-4329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC113901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical