Provider Demographics
NPI:1003695503
Name:PROCACCINI, MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:PROCACCINI
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 1:135 HARRISVILLE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02830-1413
Mailing Address - Country:US
Mailing Address - Phone:401-568-1340
Mailing Address - Fax:
Practice Address - Street 1:135 HARRISVILLE MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:RI
Practice Address - Zip Code:02830-1413
Practice Address - Country:US
Practice Address - Phone:401-568-1340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI27603103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool