Provider Demographics
NPI:1033412507
Name:MAY, JEREMY (MASTERS, LMFT)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:MAY
Suffix:
Gender:M
Credentials:MASTERS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-3849
Mailing Address - Country:US
Mailing Address - Phone:401-490-7320
Mailing Address - Fax:401-808-8685
Practice Address - Street 1:1471 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-3849
Practice Address - Country:US
Practice Address - Phone:401-490-7320
Practice Address - Fax:401-808-8685
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
RIMFT00155106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGH57134Medicaid