Individual
CHANTEL BANNERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BACHELORS
Contact information
Practice address
101 BACON ST, PAWTUCKET, RI 02860-5542
(401) 724-8400
(401) 722-5280
Mailing address
101 BACON ST, PAWTUCKET, RI 02860-5542
(401) 724-8400
(401) 722-5280
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GH57134
—
RI
Enumeration date
12/11/2013
Last updated
12/11/2013
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