Provider Demographics
NPI:1609997295
Name:BISSONNETTE, ROSE CONSTANCE (LICSW)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:CONSTANCE
Last Name:BISSONNETTE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 COLLEGE HILL RD STE 30E
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2767
Mailing Address - Country:US
Mailing Address - Phone:401-821-6070
Mailing Address - Fax:401-821-6047
Practice Address - Street 1:33 COLLEGE HILL RD STE 30E
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2767
Practice Address - Country:US
Practice Address - Phone:401-821-6070
Practice Address - Fax:401-821-6047
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW012211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI408623OtherBLUE CHIP
RI30184-6OtherBLUE CROSS & BLUE SHIELD
RI6250114OtherUNITED BEHAVIORAL HEALTH
RI1021900OtherBEACON HEALTH STRATEGIES