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General NPI Number Information
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NPI Number | 1396492864
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Entity Type | Organization
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Legal Business Name | SUSAN AUBUT
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Dates
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Enumeration Date | 03/04/2022
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Last Update Date | 03/04/2022
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Provider Practice Location Address
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Address Line | 193 WATERMAN ST
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City | PROVIDENCE
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State | RI
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Zip | 02906-4064
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Country | US
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Telephone | 401-241-4039
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Fax |
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Provider Business Mailing Address
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Address Line | 63 LILAC ST
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City | CUMBERLAND
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State | RI
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Zip | 02864-6403
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL MENTAL HEALTH COUNSELOR
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Name | SUSAN AUBUT
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Credential |
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Telephone | 401-241-4039
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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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