Provider Demographics
NPI:1609978709
Name:PEACOCK, SHARON ANN (MED)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:ANN
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MS
Other - First Name:SHARIE
Other - Middle Name:ANN
Other - Last Name:PEACOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED
Mailing Address - Street 1:1169 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLD TOWN
Mailing Address - State:ME
Mailing Address - Zip Code:04468-2022
Mailing Address - Country:US
Mailing Address - Phone:207-827-7878
Mailing Address - Fax:207-827-6900
Practice Address - Street 1:1169 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD TOWN
Practice Address - State:ME
Practice Address - Zip Code:04468-2022
Practice Address - Country:US
Practice Address - Phone:207-827-7878
Practice Address - Fax:207-827-6900
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC981101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health