Provider Demographics
NPI:1073836946
Name:MANSFIELD MARCACCIO, ABIGAIL K (PHD)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:K
Last Name:MANSFIELD MARCACCIO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 DANIELSON PIKE
Mailing Address - Street 2:
Mailing Address - City:NORTH SCITUATE
Mailing Address - State:RI
Mailing Address - Zip Code:02857-1892
Mailing Address - Country:US
Mailing Address - Phone:401-895-7897
Mailing Address - Fax:
Practice Address - Street 1:420 SCRABBLETOWN RD STE A
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-3638
Practice Address - Country:US
Practice Address - Phone:401-268-5333
Practice Address - Fax:855-268-5333
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01170103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPS01170OtherLICENSE