Healthcare Provider Details

I. General information

NPI: 1538599345
Provider Name (Legal Business Name): AMY AUDET LCSW, LCDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 HOWARD AVE
CRANSTON RI
02920-3001
US

IV. Provider business mailing address

1881 SMITH ST
NORTH PROVIDENCE RI
02911-1903
US

V. Phone/Fax

Practice location:
  • Phone: 401-462-3469
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP00600
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW01624
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: