Individual
JOHANNY MATOS CIPRIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1020 PARK AVE, PROVIDENCE, RI 02910-3227
(401) 396-7649
Mailing address
111 WAYLAND AVE, PROVIDENCE, RI 02906-4371
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDP00996
RI
Other
Enumeration date
07/25/2024
Last updated
06/16/2025
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