Healthcare Provider Details

I. General information

NPI: 1104480243
Provider Name (Legal Business Name): C & C PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PURCHASE ST STE 301
FALL RIVER MA
02720-3100
US

IV. Provider business mailing address

87 KAY ST
NEWPORT RI
02840-2843
US

V. Phone/Fax

Practice location:
  • Phone: 774-644-2254
  • Fax:
Mailing address:
  • Phone: 774-644-2254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. KAREN CADWALADER
Title or Position: OWNER
Credential: APRN
Phone: 774-644-2254