Healthcare Provider Details

I. General information

NPI: 1093283871
Provider Name (Legal Business Name): MARISSA REBECCA CARAMELLO BA, CRT, C-SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RANDALL SQ STE 302
PROVIDENCE RI
02904-2773
US

IV. Provider business mailing address

1 RANDALL SQ STE 302
PROVIDENCE RI
02904-2773
US

V. Phone/Fax

Practice location:
  • Phone: 401-443-5252
  • Fax: 401-633-7163
Mailing address:
  • Phone: 401-443-5252
  • Fax: 401-633-7163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberRCP01562
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: