Provider Demographics
NPI:1073855631
Name:RESONANCE, LLC
Entity Type:Organization
Organization Name:RESONANCE, LLC
Other - Org Name:GRACIOUS AUDETTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GRACIOUS
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:AUDETTE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:401-841-9198
Mailing Address - Street 1:7 RHODE ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2606
Mailing Address - Country:US
Mailing Address - Phone:401-841-9198
Mailing Address - Fax:401-841-9198
Practice Address - Street 1:7 RHODE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2606
Practice Address - Country:US
Practice Address - Phone:401-841-9198
Practice Address - Fax:401-841-9198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW021781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty