Healthcare Provider Details

I. General information

NPI: 1467903344
Provider Name (Legal Business Name): NEW ENGLAND CENTER FOR ANXIETY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 BROAD ST SUITE B
WESTERLY RI
02891-1977
US

IV. Provider business mailing address

43 BROAD ST SUITE B
WESTERLY RI
02891-1977
US

V. Phone/Fax

Practice location:
  • Phone: 401-596-2302
  • Fax: 401-596-0088
Mailing address:
  • Phone: 401-596-2302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW02592
License Number StateRI

VIII. Authorized Official

Name: MARIE-CLAIRE CORNILLON
Title or Position: SOCIAL WORKER
Credential: LICSW
Phone: 617-504-1208