Provider Demographics
NPI:1366919797
Name:PUTERA, MARY (LMHC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:PUTERA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 PLAIN RD
Mailing Address - Street 2:
Mailing Address - City:WEST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02817
Mailing Address - Country:US
Mailing Address - Phone:401-239-7981
Mailing Address - Fax:
Practice Address - Street 1:216 PLAIN RD
Practice Address - Street 2:
Practice Address - City:WEST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02817
Practice Address - Country:US
Practice Address - Phone:401-239-7981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00155103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMHC00155OtherSTATE LICENSE