Provider Demographics
NPI:1750365896
Name:CESANA, ALICE M (MA, LMHC)
Entity type:Individual
Prefix:MS
First Name:ALICE
Middle Name:M
Last Name:CESANA
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 899
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02813-0899
Mailing Address - Country:US
Mailing Address - Phone:401-364-7705
Mailing Address - Fax:401-364-3310
Practice Address - Street 1:4705 OLD POST RD UNIT A
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02813-1842
Practice Address - Country:US
Practice Address - Phone:401-364-7705
Practice Address - Fax:401-364-3310
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00510101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1255327391OtherBSBCRI
RI1750365896OtherUBH
RI2068329OtherCIGNA
RI1750365896Medicaid
RI491514OtherMHN/TRICARE