MEDICARE: MS. ELAINE JOYCE CASQUARELLI M.ED., ED.S., LMHC

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	101YM0800X	Mental Health Counselor	CCMH0209151	NM
2	101YM0800X	Mental Health Counselor	MHC01592	RI

General Provider Information

NPI Number	:	1679960876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELAINE JOYCE CASQUARELLI M.ED., ED.S., LMHC

Provider Business Mailing Address
First Line	:	63 SOCKANOSSET CROSS RD # 2A-4
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02920-5557
Country	:	US
Telephone Number	:	505-490-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	63 SOCKANOSSET CROSS RD STE 2A-4
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02920-5557
Country	:	US
Telephone Number	:	505-490-5600
Fax Number	:

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

Provider Enumeration Date	:	04/25/2015
Last Update Date	:	04/12/2024

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