Provider Demographics
NPI:1306481940
Name:GIRON, ROSA G (LMHC, LCDP)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:G
Last Name:GIRON
Suffix:
Gender:F
Credentials:LMHC, LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 POCASSET AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-4603
Mailing Address - Country:US
Mailing Address - Phone:401-787-3420
Mailing Address - Fax:
Practice Address - Street 1:2220 PLAINFIELD PIKE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02921-2031
Practice Address - Country:US
Practice Address - Phone:401-889-3788
Practice Address - Fax:401-223-6506
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00778101YA0400X
RIMHC01083101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty