Provider Demographics
NPI:1154637478
Name:FRIAS, TERESA M (MA, LMHC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:FRIAS
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-2025
Mailing Address - Country:US
Mailing Address - Phone:401-434-2920
Mailing Address - Fax:
Practice Address - Street 1:410 N BROADWAY
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-2025
Practice Address - Country:US
Practice Address - Phone:401-434-2920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00453101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health