Healthcare Provider Details

I. General information

NPI: 1902464829
Provider Name (Legal Business Name): MARK CHUOKE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 KING PHILIP RD
RUMFORD RI
02916-3517
US

IV. Provider business mailing address

31 BORDEN ST
RIVERSIDE RI
02915-5672
US

V. Phone/Fax

Practice location:
  • Phone: 860-481-2262
  • Fax:
Mailing address:
  • Phone: 860-481-1351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK CHUOKE
Title or Position: OWNER
Credential: LCSW
Phone: 860-481-1351