Healthcare Provider Details

I. General information

NPI: 1427247477
Provider Name (Legal Business Name): JESSICA MONTEIRO MASTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 BEECHWOOD AVE
PAWTUCKET RI
02860-5402
US

IV. Provider business mailing address

160 BEECHWOOD AVE
PAWTUCKET RI
02860-5402
US

V. Phone/Fax

Practice location:
  • Phone: 401-724-8400
  • Fax: 401-365-1100
Mailing address:
  • Phone: 401-724-8400
  • Fax: 401-365-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW02486
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: