Request for Listing on Massachusetts & Rhode Island Therapists of Color Directory
Hello there!

This is a form to be filled out by practicing therapists in the Massachusetts and Rhode Island area who are people of color. This feeds into an organized, public list that anyone on the Internet can see. It is meant to assist with referrals, help clinicians of color find each other, and provide potential clients with a centralized list of therapists of color, which is in high demand in our area.

Please DO NOT enter your information on this form if you are NOT a clinician of color. Regardless of other identities, this list is not for White therapists. Furthermore, do NOT use this for promotions.

If you have any concerns about this list, please email assistant@aidamanduley.com

The responses to this form can be viewed at http://bit.ly/maripoctherapists

[OUR MONTHLY GROUP IS CURRENTLY ON HIATUS BUT OUR LISTSERV IS ACTIVE]

We also host a monthly meeting / peer consultation group on the 2nd Thursday of the month from 6pm-8pm at The Meeting Point (3464 Washington Street in Jamaica Plain, MA). For more information on that, you may check our Facebook page for upcoming meetings (https://www.facebook.com/pg/themeetingpointJP/events/) and/or request to join our GoogleGroup (https://groups.google.com/forum/#!forum/cliniciansofcolor)

Thank you!
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Full Name *
License Type and/or Degrees (e.g. LICSW, Ph.D, LMFT, etc.) *
Name of Agency/Organization/Practice
Ethnicity and/or Race (Check all that apply) *
Required
Nationality and/or Relevant Cultural Groups
Languages (Spoken, Written, and/or Signed) *
Website URL
State(s) Where You Practice *
Required
Primary City Where You Practice *
Street Address and Zip Code *
Work Phone Number *
Work Email *
Insurances Accepted
Sliding Scale/Responsive Fee System Available? *
Areas of Clinical Focus & Treatment
Treatment Modalities & Practice Theories
Populations You Specialize In
Experience working with queer people of color? *
Experience working with trans and/or gender diverse people of color? *
Other Therapeutic Contact Styles Offered?
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