MEDICARE: CAROL ANN REINERT LCDP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCDP00064	RI
2	101YM0800X	Mental Health Counselor	MHC00381	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053467936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL ANN REINERT LCDP

Provider Business Mailing Address
First Line	:	1274 MIDDLEBRIDGE RD
Second Line	:
City	:	WAKEFIELD
State	:	RI
Zip	:	02879-7149
Country	:	US
Telephone Number	:	401-331-1350
Fax Number	:	401-277-3366

Provider Business Practice Location Address
First Line	:	650 TEN ROD RD
Second Line	:	UNIT 13
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-4238
Country	:	US
Telephone Number	:	401-331-1350
Fax Number	:	401-277-3366

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	10/24/2008

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Directions to “ CAROL ANN REINERT LCDP” Practice Location

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