Healthcare Provider Details

I. General information

NPI: 1558051862
Provider Name (Legal Business Name): KAREN MALDONADO DOUCET LMHC, CAGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 05/28/2023
Certification Date: 05/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 EATON ST
PROVIDENCE RI
02908-2153
US

IV. Provider business mailing address

PO BOX 28574
PROVIDENCE RI
02908-0574
US

V. Phone/Fax

Practice location:
  • Phone: 401-575-2336
  • Fax:
Mailing address:
  • Phone: 401-575-2336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC01510
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberMHC01510
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberMHC01510
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: