Healthcare Provider Details

I. General information

NPI: 1881845592
Provider Name (Legal Business Name): MELISSA M. MCNEIL MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST POTTER 2
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

593 EDDY ST APC 978
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-2128
  • Fax: 401-444-8836
Mailing address:
  • Phone: 401-444-4318
  • Fax: 401-444-7865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT00114
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: