Individual
MICHAEL CANCILLIERE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMHC
Contact information
Practice address
1070 MAIN ST, PAWTUCKET, RI 02860-4847
(401) 727-6413
Mailing address
528 N MAIN ST, PROVIDENCE, RI 02904-5757
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MHC00253
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29719-0
BLUE CROSS
RI
01
—
412738
BLUE CHIP
RI
01
—
62-29029
UNITED BEHAVIORAL HEALTH
RI
05
—
MC57460
—
RI
Enumeration date
06/25/2006
Last updated
11/26/2007
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