is a Addiction (substance Use Disorder) in Providence, Rhode Island. practices all healthcare services and medical treatments related to Addiction (substance Use Disorder). The NPI Number for is 1962514869. The last update date is .
's current location address is 110 Elmwood Ave, Providence, Rhode Island. You can contact this provider via phone number 4014326029 and fax number 4013005656. The mailing address for is 110 Elmwood Ave, Providence, Rhode Island. To know further, please read the information below!
Provider Profile Detail
Provider Name | |
---|---|
Address | 110 Elmwood Ave, Providence, Rhode Island |
Phone Number | 4014326029 |
Fax Number | 4013005656 |
Sole Proprietor | -- |
Credentials | -- |
NPI Number Detail
NPI Number | 1962514869 |
---|---|
Provider Enumeration Date | |
Last Updated Date |
Provider Mailing Address Detail
Address | 110 Elmwood Ave |
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City | Providence |
State | Rhode Island (RI) |
Post Code | 29072423 |
Phone Number | 4014326029 |
Fax Number | 4013005656 |
Provider's Primary Taxonomy Detail
Speciality | Addiction (substance Use Disorder) |
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Taxonomy | 103Ta0400X |
Licence No | LCDP00129 |
Definition: A psychologist with a proficiency that involves the application of psychological treatment of addiction stemming from the use of alcohol and other psychoactive substances (e.g., nicotine, marijuana, cocaine, heroin) or behavioral addictions (e.g., ga |
Provider's Other Legacy Identifiers
Identifier | Identifier Type | Identifier State | Identifier Issuer |
---|---|---|---|
412210 | RI | BLUE CHIP | |
29290 8 | RI | BLUE CROSS | |
LJ55332 | RI | -- |
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