Provider Demographics
NPI:1053341511
Name:PIKE, CONSTANCE (LICSW)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:PIKE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HOLTSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:MA
Mailing Address - Zip Code:01364-9736
Mailing Address - Country:US
Mailing Address - Phone:978-544-6699
Mailing Address - Fax:
Practice Address - Street 1:110 HOLTSHIRE RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:MA
Practice Address - Zip Code:01364-9736
Practice Address - Country:US
Practice Address - Phone:978-544-6699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1016310101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health