Provider Demographics
NPI:1679636252
Name:JALETTE, ROSEMARIE (LCDP)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:JALETTE
Suffix:
Gender:F
Credentials:LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL FALLS
Mailing Address - State:RI
Mailing Address - Zip Code:02863-3029
Mailing Address - Country:US
Mailing Address - Phone:401-726-8080
Mailing Address - Fax:401-726-8087
Practice Address - Street 1:51 CLAY ST
Practice Address - Street 2:
Practice Address - City:CENTRAL FALLS
Practice Address - State:RI
Practice Address - Zip Code:02863-3029
Practice Address - Country:US
Practice Address - Phone:401-726-8080
Practice Address - Fax:401-726-8087
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILCDP000057101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICONTRACTMedicaid