Provider Demographics
NPI:1275037236
Name:HAPPY LIFE COUNSELING OF RI
Entity Type:Organization
Organization Name:HAPPY LIFE COUNSELING OF RI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ELISY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCO-MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:401-787-3928
Mailing Address - Street 1:112 PROVIDENCE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-1027
Mailing Address - Country:US
Mailing Address - Phone:401-787-3928
Mailing Address - Fax:
Practice Address - Street 1:230 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-3430
Practice Address - Country:US
Practice Address - Phone:401-787-3928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIICSW01995261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)