| None | |
|
1704 Broad St Cranston RI 02905-2720 | |
| (401) 461-5555 | |
| (401) 461-5599 |
| Full Name | None |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 1704 Broad St, Cranston, Rhode Island |
| Authorized Official Name and Position | Karen E. Maine (ADDICTIONS COUNSELOR) |
| Authorized Official Contact | 4014615555 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| None 1704 Broad St Cranston RI 02905-2720 Ph: (401) 461-5555 | None 1704 Broad St Cranston RI 02905-2720 Ph: (401) 461-5555 |
| NPI Number | 1902085467 |
|---|---|
| Provider Enumeration Date | 10/31/2007 |
| Last Update Date | 10/31/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902085467 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | LCDP00390 (Rhode Island) | Primary |
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