Provider Demographics
NPI:1316078983
Name:MINARIK, MAUREEN LAFERTY (PHD)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:LAFERTY
Last Name:MINARIK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LANTERN LN
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-5614
Mailing Address - Country:US
Mailing Address - Phone:401-294-8753
Mailing Address - Fax:
Practice Address - Street 1:1 LANTERN LN
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-5614
Practice Address - Country:US
Practice Address - Phone:401-294-8753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS000714103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical