Provider Demographics
NPI:1225620065
Name:SOARES, NINA TAIZE (LMHC)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:TAIZE
Last Name:SOARES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 PURCHASE ST
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-5037
Mailing Address - Country:US
Mailing Address - Phone:774-930-6729
Mailing Address - Fax:
Practice Address - Street 1:55 JOHN CLARKE RD STE B-11
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-7639
Practice Address - Country:US
Practice Address - Phone:774-930-6729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC01071101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health