Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | MHC00041 | RI |
N | 101YM0800X | Mental Health Counselor | MHC00041 | RI |
NPI | 1003958729 |
---|---|
Provider Name | Mrs. Patricia Ann Ursillo |
First Address | No Kingstown, RI 02852-3315 |
Second Address | No Kingstown, RI 02852-3315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
70955 | BLUE CROSS (01) |