Provider Demographics
NPI:1215965371
Name:WAITE, JOANNE M (LMFT)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:M
Last Name:WAITE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MULBERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-1072
Mailing Address - Country:US
Mailing Address - Phone:401-297-1379
Mailing Address - Fax:401-845-2258
Practice Address - Street 1:55 MULBERRY ROAD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-1072
Practice Address - Country:US
Practice Address - Phone:401-297-1379
Practice Address - Fax:401-845-2258
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1223106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI257756OtherBLUE CROSS BLUE SHIELD
RI6230216OtherUNITED HEALTHCARE