Provider Demographics
NPI:1053011619
Name:INFANTE, MICHAEL (MHC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:INFANTE
Suffix:
Gender:M
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-2216
Mailing Address - Country:US
Mailing Address - Phone:401-543-8467
Mailing Address - Fax:
Practice Address - Street 1:42 VALLEY RD STE 3C
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-6376
Practice Address - Country:US
Practice Address - Phone:401-842-0089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC01452101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health