Provider Demographics
NPI:1972677722
Name:ST. MARY'S HOME FOR CHILDREN
Entity Type:Organization
Organization Name:ST. MARY'S HOME FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTPATIENT CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:BARNETT
Authorized Official - Last Name:LAFOUNTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:401-784-3530
Mailing Address - Street 1:420 FRUIT HILL AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-2626
Mailing Address - Country:US
Mailing Address - Phone:401-353-3900
Mailing Address - Fax:401-784-3549
Practice Address - Street 1:420 FRUIT HILL AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02911-2626
Practice Address - Country:US
Practice Address - Phone:401-353-3900
Practice Address - Fax:401-784-3549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00274251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health