Provider Demographics
NPI:1467903344
Name:NEW ENGLAND CENTER FOR ANXIETY LLC
Entity Type:Organization
Organization Name:NEW ENGLAND CENTER FOR ANXIETY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE-CLAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNILLON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-504-1208
Mailing Address - Street 1:43 BROAD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-1977
Mailing Address - Country:US
Mailing Address - Phone:401-596-2302
Mailing Address - Fax:
Practice Address - Street 1:43 BROAD ST
Practice Address - Street 2:SUITE B
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-1977
Practice Address - Country:US
Practice Address - Phone:401-596-2302
Practice Address - Fax:401-596-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW025921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty