Provider Demographics
NPI:1881918738
Name:PIERCE, LUCILLE J (LMT)
Entity type:Individual
Prefix:MS
First Name:LUCILLE
Middle Name:J
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 CLARK ST APT 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3834
Mailing Address - Country:US
Mailing Address - Phone:518-221-3350
Mailing Address - Fax:
Practice Address - Street 1:193 CLARK ST APT 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3834
Practice Address - Country:US
Practice Address - Phone:518-221-3350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT4062225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist