Provider Demographics
NPI:1346920857
Name:LANDRIE, AARON OAKMAN
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:OAKMAN
Last Name:LANDRIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 PARKER ST APT 1
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4129
Mailing Address - Country:US
Mailing Address - Phone:701-620-1627
Mailing Address - Fax:
Practice Address - Street 1:47 PARKER ST APT 1
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4129
Practice Address - Country:US
Practice Address - Phone:701-620-1627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2294371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical