Provider Demographics
NPI:1699865154
Name:IANNELLI, NICOLE MICHELLE (LCMHC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MICHELLE
Last Name:IANNELLI
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02921-1015
Mailing Address - Country:US
Mailing Address - Phone:401-497-5108
Mailing Address - Fax:
Practice Address - Street 1:54 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02921-1015
Practice Address - Country:US
Practice Address - Phone:401-497-5108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00175101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI409945OtherBLUE CHIP
RI231701OtherBLUE CROSS BLUE SHIELD
RI6247759OtherUNITED HEALTH CARE
RINI43573Medicaid
RI470077OtherTUFTS