Provider Demographics
NPI:1376575902
Name:MCBRINE, MARISA C (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:C
Last Name:MCBRINE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-1712
Mailing Address - Country:US
Mailing Address - Phone:401-438-9500
Mailing Address - Fax:
Practice Address - Street 1:667 WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1712
Practice Address - Country:US
Practice Address - Phone:401-438-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00847235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI6400144OtherSS UHP
RI99947OtherSS BCROSS
RI2058OtherSS NHPRC
RI9009994Medicaid