Provider Demographics
NPI:1427765304
Name:BIBEAULT, MELISSA A
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:BIBEAULT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 SIMMONSVILLE AVE APT 3104
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-6077
Mailing Address - Country:US
Mailing Address - Phone:401-258-3936
Mailing Address - Fax:
Practice Address - Street 1:63 EDDIE DOWLING HWY STE 7
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-7322
Practice Address - Country:US
Practice Address - Phone:401-766-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor