Healthcare Provider Details

I. General information

NPI: 1043502214
Provider Name (Legal Business Name): ME PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 WATERMAN ST
PROVIDENCE RI
02906-4015
US

IV. Provider business mailing address

194 WATERMAN ST
PROVIDENCE RI
02906-4015
US

V. Phone/Fax

Practice location:
  • Phone: 401-633-2929
  • Fax: 888-602-6957
Mailing address:
  • Phone: 401-633-2929
  • Fax: 888-602-6957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHC00342
License Number StateRI

VIII. Authorized Official

Name: MS. MARISA ETTING
Title or Position: PRESIDENT
Credential: LCMHC
Phone: 401-633-2929