Provider Demographics
NPI:1134457989
Name:ANDREWS, JO-ANN PETRUCCI (MA, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JO-ANN
Middle Name:PETRUCCI
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 OLD DANIELSON PIKE
Mailing Address - Street 2:
Mailing Address - City:FOSTER
Mailing Address - State:RI
Mailing Address - Zip Code:02825-1458
Mailing Address - Country:US
Mailing Address - Phone:401-647-0482
Mailing Address - Fax:
Practice Address - Street 1:57 OLD DANIELSON PIKE
Practice Address - Street 2:
Practice Address - City:FOSTER
Practice Address - State:RI
Practice Address - Zip Code:02825-1458
Practice Address - Country:US
Practice Address - Phone:401-647-0482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00452101Y00000X, 101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI101Y00000XMedicaid