Provider Demographics
NPI:1710233598
Name:REID, CARMEN (MASTERS)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:REID
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 1:225 NEWMAN AVE
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-1218
Mailing Address - Country:US
Mailing Address - Phone:401-270-7110
Mailing Address - Fax:401-490-7694
Practice Address - Street 1:225 NEWMAN AVE
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:RI
Practice Address - Zip Code:02916-1218
Practice Address - Country:US
Practice Address - Phone:401-270-7110
Practice Address - Fax:401-490-7694
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGH57134Medicaid