Healthcare Provider Details

I. General information

NPI: 1902797806
Provider Name (Legal Business Name): RHODE OBAS APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 FARMINGTON AVE
BRISTOL CT
06010-3990
US

IV. Provider business mailing address

1001 FARMINGTON AVE STE 103
BRISTOL CT
06010-3990
US

V. Phone/Fax

Practice location:
  • Phone: 303-435-7506
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number11051
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: