Healthcare Provider Details

I. General information

NPI: 1467529537
Provider Name (Legal Business Name): SUZANNE CAROL SWANSON RNC MS LCDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUZANNE CAROL ASHTON TCN

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 NEWMAN AVE
RUMFORD RI
02916-1218
US

IV. Provider business mailing address

225 NEWMAN AVE
RUMFORD RI
02916-1218
US

V. Phone/Fax

Practice location:
  • Phone: 401-431-9800
  • Fax: 401-431-9801
Mailing address:
  • Phone: 401-431-9800
  • Fax: 401-431-9801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number00037
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number00037
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN11335
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: