Individual
AMANDA L FONTAINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
23 NORTH RD STE A25, PEACE DALE, RI 02879-2176
(401) 487-7042
Mailing address
23 NORTH RD STE A25, PEACE DALE, RI 02879-2176
(401) 487-7042
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MFT00098
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1023290
NEIGHBORHOOD HEALTH OF RI
RI
01
—
27655-1
BLUE CROSS
RI
01
—
411932
BLUE CHIP
RI
05
—
AO54832
—
RI
05
—
FM49368
—
RI
Enumeration date
07/03/2006
Last updated
01/22/2020
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