Provider Demographics
NPI:1023560976
Name:REI-MOHAMMED, MARIANA (MA, BS, BA)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:REI-MOHAMMED
Suffix:
Gender:F
Credentials:MA, BS, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 ELLENFIELD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4541
Mailing Address - Country:US
Mailing Address - Phone:401-444-6779
Mailing Address - Fax:401-444-6912
Practice Address - Street 1:105 BACON ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5542
Practice Address - Country:US
Practice Address - Phone:401-722-3560
Practice Address - Fax:401-722-5280
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC01069101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health