Healthcare Provider Details

I. General information

NPI: 1629634035
Provider Name (Legal Business Name): GABRIELLA A CARCANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 CHESTNUT ST STE 200
PROVIDENCE RI
02903-4604
US

IV. Provider business mailing address

9 LEEDER ST
WEST WARWICK RI
02893-3813
US

V. Phone/Fax

Practice location:
  • Phone: 401-287-4012
  • Fax:
Mailing address:
  • Phone: 401-287-4012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP01106
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: