Provider Demographics
NPI:1720850365
Name:EMPOWERING ROAD, LLC
Entity Type:Organization
Organization Name:EMPOWERING ROAD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAZZILLI
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:401-400-2403
Mailing Address - Street 1:PO BOX 100252
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-0064
Mailing Address - Country:US
Mailing Address - Phone:401-400-2403
Mailing Address - Fax:
Practice Address - Street 1:10 DAVOL SQ STE 100
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4752
Practice Address - Country:US
Practice Address - Phone:401-400-2403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty