Individual
SUSAN MONTAQUILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC, LCDP
Contact information
Practice address
111 HOWARD AVE BLDG 56, CRANSTON, RI 02920-3001
(401) 462-1021
Mailing address
528 N MAIN ST, PROVIDENCE, RI 02904-5757
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCDP00239
RI
101YM0800X
Mental Health Counselor
Primary
MHC00329
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104847946
THE PROVIDENCE CENTER NPI
RI
01
—
32427-4
BLUE CROSS
RI
01
—
414072
BLUE CHIP
RI
01
—
62-42464
UBH
RI
05
—
SM55220
—
RI
Enumeration date
06/10/2006
Last updated
03/30/2009
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