=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295875516
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAMONA MELLO LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2007
-----------------------------------------------------
Last Update Date | 03/15/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 62 GESLER ST
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02909-1506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-831-2794
-----------------------------------------------------
Fax | 401-490-0548
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 71 GOVERNOR BRADFORD DR
-----------------------------------------------------
City | BARRINGTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02806-4732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-480-1636
-----------------------------------------------------
Fax | 401-354-2191
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | ISW01692
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------