Basic Information
| Provider Information | |||||||||
| NPI: | 1952618720 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SINGLETON | ||||||||
| FirstName: | MARISA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 249 ROOSEVELT AVE | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028602134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017248400 | ||||||||
| FaxNumber: | 4017225280 | ||||||||
| Practice Location | |||||||||
| Address1: | 101-105 BACON ST | ||||||||
| Address2: | |||||||||
| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028605542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017248400 | ||||||||
| FaxNumber: | 4017225280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2010 | ||||||||
| LastUpdateDate: | 08/11/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | NPP37781 | RI | N | Nursing Service Providers | Licensed Practical Nurse | 363LP0808X | NPP37781 | RI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1952618720 | 05 | RI | MEDICAID | GH57134 | 05 | RI | MEDICAID | 1952618720 | 01 | RI | BLUE CROSS BLUE SHIELD RI | OTHER | 549744 | 01 | RI | MHN/TRICARE | OTHER | 1952618720 | 01 | RI | UNITED HEALTH CARE | OTHER | 12588497 | 01 | RI | CIGNA | OTHER | 762493 | 01 | RI | VALUEOPTIONS | OTHER | 1952618720 | 01 | RI | TUFTS | OTHER |