Provider Demographics
NPI:1548537681
Name:SMITH, ROSITA VIDAURRE (MASTERS)
Entity type:Individual
Prefix:
First Name:ROSITA
Middle Name:VIDAURRE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 BEECHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5402
Mailing Address - Country:US
Mailing Address - Phone:401-722-5573
Mailing Address - Fax:401-726-5571
Practice Address - Street 1:160 BEECHWOOD AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5402
Practice Address - Country:US
Practice Address - Phone:401-722-5573
Practice Address - Fax:401-726-5571
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGH57134Medicaid