Provider Demographics
NPI:1306082011
Name:VINCENT, THELMISHA (BCBA, LMHC)
Entity type:Individual
Prefix:
First Name:THELMISHA
Middle Name:
Last Name:VINCENT
Suffix:
Gender:F
Credentials:BCBA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 EARL AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-3204
Mailing Address - Country:US
Mailing Address - Phone:401-441-2982
Mailing Address - Fax:401-808-6333
Practice Address - Street 1:66 EARL AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-3204
Practice Address - Country:US
Practice Address - Phone:401-441-2982
Practice Address - Fax:401-808-6333
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00395101YM0800X
MA1-07-3317103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst