Provider Demographics
NPI:1952618720
Name:SINGLETON, MARISA ANN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:ANN
Last Name:SINGLETON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 ROOSEVELT AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-2134
Mailing Address - Country:US
Mailing Address - Phone:401-724-8400
Mailing Address - Fax:401-722-5280
Practice Address - Street 1:101-105 BACON ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5542
Practice Address - Country:US
Practice Address - Phone:401-724-8400
Practice Address - Fax:401-722-5280
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37781164W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1952618720Medicaid
RIGH57134Medicaid
RI1952618720OtherBLUE CROSS BLUE SHIELD RI
RI549744OtherMHN/TRICARE
RI1952618720OtherUNITED HEALTH CARE
RI12588497OtherCIGNA
RI762493OtherVALUEOPTIONS
RI1952618720OtherTUFTS
RIGH57134Medicaid