Healthcare Provider Details

I. General information

NPI: 1285726489
Provider Name (Legal Business Name): MARIA CELMIRA MANCEBO COLTEY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA CELMIRA MANCEBO PH.D.

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
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: 401-862-7060
  • Fax: 401-340-1675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPS00867
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS00867
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: