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General NPI Number Information
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NPI Number | 1265739791
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Entity Type | Individual
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Provider Name | MAEVE L VAILLANCOURT M.A.
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Gender | Female
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Dates
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Enumeration Date | 02/18/2011
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 71 GRACE ST
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City | CRANSTON
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State | RI
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Zip | 02910-2034
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Country | US
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Telephone | 401-871-7846
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Fax |
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Provider Business Mailing Address
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Address Line | 9 GUNNING CT
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City | MIDDLETOWN
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State | RI
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Zip | 02842-5814
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Country | US
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Telephone | 401-835-5238
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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