Healthcare Provider Details

I. General information

NPI: 1790375921
Provider Name (Legal Business Name): JILLIAN MARY BARNES LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 EAGLE ST
PROVIDENCE RI
02908-5657
US

IV. Provider business mailing address

12 EAGLE ST UNIT 306
PROVIDENCE RI
02908-5660
US

V. Phone/Fax

Practice location:
  • Phone: 401-474-7652
  • Fax:
Mailing address:
  • Phone: 401-474-7652
  • 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:
Title or Position:
Credential:
Phone: