Provider Demographics
NPI:1659580827
Name:MCNIFF, LAURIE (LICSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:MCNIFF
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:MILNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1165 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5740
Mailing Address - Country:US
Mailing Address - Phone:401-331-1244
Mailing Address - Fax:401-331-5772
Practice Address - Street 1:1165 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5740
Practice Address - Country:US
Practice Address - Phone:401-331-1244
Practice Address - Fax:401-331-5772
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC130591041C0700X
RIISW027751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME434245499Medicaid
ME434245499Medicaid