Provider Demographics
NPI:1427046044
Name:PIWKO, CAROL A (LCMHC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:PIWKO
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 CLINTON ST
Mailing Address - Street 2:#8
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-3758
Mailing Address - Country:US
Mailing Address - Phone:603-673-7008
Mailing Address - Fax:
Practice Address - Street 1:64 SOUTH ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-3729
Practice Address - Country:US
Practice Address - Phone:603-672-4497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH442101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH14Y001203NH02OtherANTHEM BC/BS