Provider Demographics
NPI:1821168642
Name:MORENA, PATRICIA C (LMHC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:C
Last Name:MORENA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 SMITH ST
Mailing Address - Street 2:#8
Mailing Address - City:NO PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911
Mailing Address - Country:US
Mailing Address - Phone:401-353-5202
Mailing Address - Fax:401-353-0091
Practice Address - Street 1:1845 SMITH ST
Practice Address - Street 2:#8
Practice Address - City:NO PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02911
Practice Address - Country:US
Practice Address - Phone:401-353-5202
Practice Address - Fax:401-353-0091
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00060LMHC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI71457OtherBLUE CROSS
RI1020850OtherNEIGHBORHOOD
RIPM18505Medicaid