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General NPI Number Information
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NPI Number | 1114671609
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Entity Type | Individual
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Provider Name | MELISSA MCKENNA
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Gender | Female
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Dates
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Enumeration Date | 02/04/2022
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 600 PAWTUCKET AVE
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City | PAWTUCKET
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State | RI
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Zip | 02860-6059
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Country | US
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Telephone | 401-808-6278
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Fax |
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Provider Business Mailing Address
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Address Line | 12 CHURCH ST
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City | BARRINGTON
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State | RI
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Zip | 02806-2924
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Country | US
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Telephone | 401-837-2387
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDP00772
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MHC01556
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License Number State | RI
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