1275816498 NPI number — ALISHA MONIQUE LAGUERRE LICSW

Table of content: ALISHA MONIQUE LAGUERRE LICSW (NPI 1275816498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275816498 NPI number — ALISHA MONIQUE LAGUERRE LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAGUERRE
Provider First Name:
ALISHA
Provider Middle Name:
MONIQUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
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:
1275816498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6688
Provider Second Line Business Mailing Address:
C/O FAMILY SERVICE OF RI
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-331-1350
Provider Business Mailing Address Fax Number:
401-277-3366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 HOPE STREET
Provider Second Line Business Practice Location Address:
C/O FAMILY SERVICE OF RHODE ISLAND
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-331-1350
Provider Business Practice Location Address Fax Number:
401-277-3366
Provider Enumeration Date:
09/23/2011

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: 104100000X , with the licence number:  CSW01377 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: ISW02294 , 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)