MEDICARE: CHANEL RICE LPC

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	101YP2500X	Professional Counselor	2043	CT

General Provider Information

NPI Number	:	1477842318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANEL RICE LPC

Provider Business Mailing Address
First Line	:	58 WOODLEY CT APT 5
Second Line	:
City	:	MERIDEN
State	:	CT
Zip	:	06450-5862
Country	:	US
Telephone Number	:	203-785-9110
Fax Number	:

Provider Business Practice Location Address
First Line	:	59 QUINNIPIAC AVE
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-3904
Country	:	US
Telephone Number	:	203-785-9110
Fax Number	:

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

Provider Enumeration Date	:	03/31/2011
Last Update Date	:	03/31/2011

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