Healthcare Provider Details

I. General information

NPI: 1497630057
Provider Name (Legal Business Name): INNERACT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 BROADWAY
PROVIDENCE RI
02909-1101
US

IV. Provider business mailing address

21 WEST ST
PROVIDENCE RI
02903-3555
US

V. Phone/Fax

Practice location:
  • Phone: 401-757-0142
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANNAROSE SQUILLANTE
Title or Position: OWNER
Credential:
Phone: 401-757-0142