Healthcare Provider Details

I. General information

NPI: 1255187902
Provider Name (Legal Business Name): TAKE ROOT COUNSELING RI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 SMITH ST
PROVIDENCE RI
02908-3770
US

IV. Provider business mailing address

3 LINCOLN DR
JOHNSTON RI
02919-2861
US

V. Phone/Fax

Practice location:
  • Phone: 401-589-1047
  • Fax:
Mailing address:
  • Phone: 860-614-1329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: RENE NICOLETTI
Title or Position: OWNER
Credential:
Phone: 860-614-1329