Provider Demographics
NPI:1295875516
Name:MELLO, RAMONA (LICSW)
Entity type:Individual
Prefix:
First Name:RAMONA
Middle Name:
Last Name:MELLO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 GOVERNOR BRADFORD DR
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-4732
Mailing Address - Country:US
Mailing Address - Phone:401-480-1636
Mailing Address - Fax:401-354-2191
Practice Address - Street 1:62 GESLER ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-1506
Practice Address - Country:US
Practice Address - Phone:401-831-2794
Practice Address - Fax:401-490-0548
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW016921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11715378OtherCAQH
RIRM48966Medicaid