Provider Demographics
NPI:1689962565
Name:DURAND, JAIME (MASTERS)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:DURAND
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 LARCH ST
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-6712
Mailing Address - Country:US
Mailing Address - Phone:401-422-6093
Mailing Address - Fax:401-226-9381
Practice Address - Street 1:136 LARCH ST
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-6712
Practice Address - Country:US
Practice Address - Phone:401-422-6093
Practice Address - Fax:401-226-9381
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
RIMHC00615101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGH57134Medicaid