Provider Demographics
NPI:1952859035
Name:RICE, CARLY (LAC)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:RICE
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 SAINT JOHN ST STE 127
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3055
Mailing Address - Country:US
Mailing Address - Phone:802-302-9300
Mailing Address - Fax:
Practice Address - Street 1:222 SAINT JOHN ST STE 127
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3055
Practice Address - Country:US
Practice Address - Phone:802-302-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21888172V00000X
MEAC847171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No172V00000XOther Service ProvidersCommunity Health Worker