Healthcare Provider Details

I. General information

NPI: 1700354289
Provider Name (Legal Business Name): LOURDES MICHELLE CABRET RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 AIRPORT RD
WESTERLY RI
02891-3420
US

IV. Provider business mailing address

93 AIRPORT RD
WESTERLY RI
02891-3420
US

V. Phone/Fax

Practice location:
  • Phone: 401-596-2091
  • Fax: 401-596-3945
Mailing address:
  • Phone: 401-596-2091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC01960
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61377903
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: