Provider Demographics
NPI:1053759258
Name:REID-MAYNARD, CERENA (LCSW)
Entity type:Individual
Prefix:
First Name:CERENA
Middle Name:
Last Name:REID-MAYNARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CERENA
Other - Middle Name:YVETE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:455 TOLL GATE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2759
Mailing Address - Country:US
Mailing Address - Phone:401-273-0641
Mailing Address - Fax:
Practice Address - Street 1:345 BLACKSTONE BLVD
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4800
Practice Address - Country:US
Practice Address - Phone:401-455-6226
Practice Address - Fax:401-455-6604
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW025951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical