Provider Demographics
NPI:1689774721
Name:DEBALSI, MARYANNE L (MS, LMFT, LCDP II)
Entity Type:Individual
Prefix:MRS
First Name:MARYANNE
Middle Name:L
Last Name:DEBALSI
Suffix:
Gender:F
Credentials:MS, LMFT, LCDP II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:792 OAKLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-2854
Mailing Address - Country:US
Mailing Address - Phone:401-942-0039
Mailing Address - Fax:401-722-4867
Practice Address - Street 1:792 OAKLAWN AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-2854
Practice Address - Country:US
Practice Address - Phone:401-942-0039
Practice Address - Fax:401-722-4867
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI67106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist