Provider Demographics
NPI:1538675921
Name:AHLBERG, AMY JOHANNA (LMHC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:JOHANNA
Last Name:AHLBERG
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 1:75 SOCKANOSSET CROSS RD STE 206A
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-5558
Mailing Address - Country:US
Mailing Address - Phone:401-362-9157
Mailing Address - Fax:401-496-9993
Practice Address - Street 1:75 SOCKANOSSET CROSS RD STE 206A
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-5558
Practice Address - Country:US
Practice Address - Phone:401-362-9157
Practice Address - Fax:401-496-9993
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00914101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMHC00914OtherSTATE LICENSE