Provider Demographics
NPI:1376167510
Name:BERUBE, PRISCILLA HOPE (LMHC)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:HOPE
Last Name:BERUBE
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 1:28 CEDAR SWAMP RD UNIT 206
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-2447
Mailing Address - Country:US
Mailing Address - Phone:401-321-4082
Mailing Address - Fax:
Practice Address - Street 1:28 CEDAR SWAMP RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-2447
Practice Address - Country:US
Practice Address - Phone:401-321-4082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC01466101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health