Provider Demographics
NPI:1194517615
Name:GOYETTE, MIA THUY (MA, CAGS)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:THUY
Last Name:GOYETTE
Suffix:
Gender:F
Credentials:MA, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 THURBERS AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3031
Mailing Address - Country:US
Mailing Address - Phone:401-339-3290
Mailing Address - Fax:
Practice Address - Street 1:182 THURBERS AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3031
Practice Address - Country:US
Practice Address - Phone:401-339-3290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool