Provider Demographics
NPI:1073710430
Name:VANIA, DAMION (MASTERS)
Entity Type:Individual
Prefix:
First Name:DAMION
Middle Name:
Last Name:VANIA
Suffix:
Gender:M
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 BEECHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5402
Mailing Address - Country:US
Mailing Address - Phone:401-724-8400
Mailing Address - Fax:401-365-1100
Practice Address - Street 1:160 BEECHWOOD AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5402
Practice Address - Country:US
Practice Address - Phone:401-724-8400
Practice Address - Fax:401-365-1100
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI30343OtherCRISIS BLUE CROSS