Healthcare Provider Details

I. General information

NPI: 1508770819
Provider Name (Legal Business Name): MARIA MANCEBO PHD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 WATERMAN ST STE 7
PROVIDENCE RI
02906-3116
US

IV. Provider business mailing address

PO BOX 7041
CUMBERLAND RI
02864-0892
US

V. Phone/Fax

Practice location:
  • Phone: 401-361-4753
  • Fax: 401-340-1675
Mailing address:
  • Phone: 401-361-4753
  • Fax: 401-340-1675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MARA CELMIRA MANCEBO COLTEY
Title or Position: OWNER
Credential: PHD
Phone: 401-862-7060