Individual
MARIE A FONTAINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
119 FAIRFIELD DR, NORTH KINGSTOWN, RI 02852-1953
(401) 261-1297
Mailing address
119 FAIRFIELD DR, NORTH KINGSTOWN, RI 02852-1953
(401) 261-1297
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
ISW01350
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25582
BLUE CROSS
RI
01
—
408283
BLUE CHIP
RI
01
—
62-28013
UNITED BEHAVIORAL HEALTH
RI
Enumeration date
09/28/2006
Last updated
02/17/2018
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