Healthcare Provider Details

I. General information

NPI: 1881508711
Provider Name (Legal Business Name): MIA HAZARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 PARK AVE STE 211
CRANSTON RI
02910-3227
US

IV. Provider business mailing address

184 WHITING ST
CRANSTON RI
02920-4026
US

V. Phone/Fax

Practice location:
  • Phone: 401-396-7649
  • Fax: 401-208-2482
Mailing address:
  • Phone: 508-239-5234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW04646
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: