Provider Demographics
NPI:1558755082
Name:CHETEYAN, SOUAD (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:SOUAD
Middle Name:
Last Name:CHETEYAN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MOUNT PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-3836
Mailing Address - Country:US
Mailing Address - Phone:401-751-4833
Mailing Address - Fax:
Practice Address - Street 1:315 MOUNT PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-3836
Practice Address - Country:US
Practice Address - Phone:401-751-4833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)