Healthcare Provider Details

I. General information

NPI: 1073575544
Provider Name (Legal Business Name): MARY A DIONNE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 RICHMOND SQ STE 208
PROVIDENCE RI
02906-5135
US

IV. Provider business mailing address

7 HUMPHREYS RD
BARRINGTON RI
02806-1108
US

V. Phone/Fax

Practice location:
  • Phone: 401-523-2395
  • Fax:
Mailing address:
  • Phone: 401-523-2395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberISW01543
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: