Provider Demographics
NPI:1083745632
Name:MELLO, FATIMA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:FATIMA
Middle Name:
Last Name:MELLO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-3859
Mailing Address - Country:US
Mailing Address - Phone:401-435-5809
Mailing Address - Fax:
Practice Address - Street 1:474 WARREN AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-3859
Practice Address - Country:US
Practice Address - Phone:401-435-5809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW003781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI203483OtherBLUE CHIP OF RHODE ISLAND
RI32092OtherBLUE CROSS BLUE SHIELD
RI6212318OtherUNITED BEHAVIORAL HEALTH