Provider Demographics
NPI:1427849595
Name:VINCENTY, MELODIE (LMHC-A)
Entity type:Individual
Prefix:
First Name:MELODIE
Middle Name:
Last Name:VINCENTY
Suffix:
Gender:F
Credentials:LMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 PUTNAM PIKE # 1
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-2078
Mailing Address - Country:US
Mailing Address - Phone:347-604-4613
Mailing Address - Fax:
Practice Address - Street 1:1045 WARWICK AVE STE 101
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3657
Practice Address - Country:US
Practice Address - Phone:401-480-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00307-A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health