Provider Demographics
NPI:1235281742
Name:LABIANCA, LYNN M (MA)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:LABIANCA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 SELMA ST
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6356
Mailing Address - Country:US
Mailing Address - Phone:401-732-5656
Mailing Address - Fax:401-738-8634
Practice Address - Street 1:300 CENTERVILLE RD
Practice Address - Street 2:THE KENT CENTER
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-732-5656
Practice Address - Fax:401-738-8634
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI92101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RILL11136Medicaid