Healthcare Provider Details

I. General information

NPI: 1164452447
Provider Name (Legal Business Name): CHRISTINE MORICONI PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RIVER ST
WAKEFIELD RI
02879-3214
US

IV. Provider business mailing address

1 RIVER ST
WAKEFIELD RI
02879-3214
US

V. Phone/Fax

Practice location:
  • Phone: 401-783-0523
  • Fax: 401-783-9448
Mailing address:
  • Phone: 401-783-0523
  • Fax: 401-783-9448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRN203210L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberAPRN02085
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: