Provider Demographics
NPI:1295552552
Name:CHARPENTIER-THORPE, MARIE JUDITH (MS, LMHC)
Entity type:Individual
Prefix:
First Name:MARIE JUDITH
Middle Name:
Last Name:CHARPENTIER-THORPE
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 SALERNO ST
Mailing Address - Street 2:
Mailing Address - City:AVE MARIA
Mailing Address - State:FL
Mailing Address - Zip Code:34142-9578
Mailing Address - Country:US
Mailing Address - Phone:954-444-4429
Mailing Address - Fax:
Practice Address - Street 1:10 PIER 1 STE 204
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-6328
Practice Address - Country:US
Practice Address - Phone:971-257-9053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH24310101YM0800X
ORC9698101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health