| Doctor Name: | ELAINE R. PONCELET |
| NPI Number: | 1215954391 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LICSW |
| License Number: | LCDP00087 |
| Business Practice Address: | 1130 Ten Rod Rd Suite D 205 North Kingstown, RI - 028524161 |
| Business Phone Number: | 4012949500 |
| Business Fax Number: | 4012949500 |
| Mailing Address: | 1130 Ten Rod Rd, Suite D 205 NORTH KINGSTOWN |
| State: | RI |
| Postal Code: | 028524161 |
| Phone Number: | 4012949500 |
| Fax Number: | 4012949500 |
| NPI Enumeration Date: | 07/16/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | LCDP00087 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | RI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |