Provider Demographics
NPI:1831678614
Name:DESMARAIS, MEGHAN (LMHC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:DESMARAIS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:
Other - Last Name:KEOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:1 RICHMOND SQ
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5139
Mailing Address - Country:US
Mailing Address - Phone:401-705-0040
Mailing Address - Fax:
Practice Address - Street 1:22 CORMIER RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-3112
Practice Address - Country:US
Practice Address - Phone:802-738-0371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-12
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC01526101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health