Provider Demographics
NPI:1245501253
Name:CHARPENTIER, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:CHARPENTIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543
Mailing Address - Country:US
Mailing Address - Phone:508-583-5800
Mailing Address - Fax:580-276-0182
Practice Address - Street 1:468 MAIN STREET
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543
Practice Address - Country:US
Practice Address - Phone:508-583-5800
Practice Address - Fax:580-276-0182
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME384237700000X
MA220237700000X
NHH553237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist