Individual
MARYGENE MANANSALA SANTA TERESA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
530 NORTH MAIN STREET, THE PROVIDENCE CENTER, PROVIDENCE, RI 02904
(401) 528-0110
(401) 276-4111
Mailing address
41 EMILY LN, WARWICK, RI 02886-4527
(201) 647-9831
(401) 276-4111
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
041649
CT
2084P0800X
Psychiatry Physician
Primary
11597
RI
Other
Enumeration date
08/07/2006
Last updated
10/04/2011
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