Basic Information
| Provider Information | |||||||||
| NPI: | 1942687108 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | L'ETOILE | ||||||||
| FirstName: | MELODY | ||||||||
| MiddleName: | CELINE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 49 HIGH VIEW AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH SMITHFIELD | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028967731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014396456 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 63 EDDIE DOWLING HWY STE 9 | ||||||||
| Address2: | |||||||||
| City: | NORTH SMITHFIELD | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028967322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014143485 | ||||||||
| FaxNumber: | 4014143486 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2015 | ||||||||
| LastUpdateDate: | 11/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.