Provider Demographics
NPI:1518083781
Name:HERRERO, CARLY HELEN (LAC)
Entity Type:Individual
Prefix:MS
First Name:CARLY
Middle Name:HELEN
Last Name:HERRERO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1620
Mailing Address - Country:US
Mailing Address - Phone:503-284-4227
Mailing Address - Fax:360-359-7750
Practice Address - Street 1:101 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2553
Practice Address - Country:US
Practice Address - Phone:503-284-4227
Practice Address - Fax:360-359-7750
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC726171100000X
OR11022174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty