Provider Demographics
NPI:1912968272
Name:PIERCE, NORMAN BRAYTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:BRAYTON
Last Name:PIERCE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1432
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02362-1432
Mailing Address - Country:US
Mailing Address - Phone:781-733-7646
Mailing Address - Fax:
Practice Address - Street 1:200 CORDWAINER DR STE 202
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1671
Practice Address - Country:US
Practice Address - Phone:781-733-7646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2986103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03088OtherBLUE SHIELD
MAW03088OtherBLUE SHIELD