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Individual

KIM MARIE MEDEIROS-CANNATA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMHC

Contact information

Practice address
82 CENTRAL PIKE, FOSTER, RI 02825-1301
(401) 658-6448
Mailing address
82 CENTRAL PIKE, FOSTER, RI 02825-1301
(401) 658-6448

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
00198
RI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
31256-1
BLUESHIELD
RI
01
413222
BLUECHIP COORDINATED HEAL
RI
Enumeration date
09/26/2006
Last updated
02/07/2021
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