Individual
MIKA LORIEN MORGAN MACINNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
291 WATERMAN ST, PROVIDENCE, RI 02906-5130
(401) 338-8818
Mailing address
64 MEMORIAL RD, PROVIDENCE, RI 02906-2720
(401) 338-8818
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS01565
RI
Other
Enumeration date
07/15/2016
Last updated
08/31/2016
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