1952618720 NPI number — MARISA ANN SINGLETON PMHNP-BC

Table of content: MARISA ANN SINGLETON PMHNP-BC (NPI 1952618720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952618720 NPI number — MARISA ANN SINGLETON PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SINGLETON
Provider First Name:
MARISA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952618720
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
249 ROOSEVELT AVE
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
PAWTUCKET
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02860-2134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-724-8400
Provider Business Mailing Address Fax Number:
401-722-5280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101-105 BACON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAWTUCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02860-5542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-724-8400
Provider Business Practice Location Address Fax Number:
401-722-5280
Provider Enumeration Date:
09/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  NPP37781 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: NPP37781 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1952618720 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: GH57134 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1952618720 . This is a "BLUE CROSS BLUE SHIELD RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 549744 . This is a "MHN/TRICARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1952618720 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 12588497 . This is a "CIGNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 762493 . This is a "VALUEOPTIONS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1952618720 . This is a "TUFTS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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