Provider Demographics
NPI:1942687108
Name:L'ETOILE, MELODY CELINE
Entity Type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:CELINE
Last Name:L'ETOILE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 HIGH VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-7731
Mailing Address - Country:US
Mailing Address - Phone:401-439-6456
Mailing Address - Fax:
Practice Address - Street 1:63 EDDIE DOWLING HWY STE 9
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-7322
Practice Address - Country:US
Practice Address - Phone:401-414-3485
Practice Address - Fax:401-414-3486
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical