Healthcare Provider Details

I. General information

NPI: 1568156180
Provider Name (Legal Business Name): CROSBY ALYSE MODROWSKI PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 01/24/2024
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 HOPE ST
BRISTOL RI
02809-1848
US

IV. Provider business mailing address

57 MOUNT HOPE AVE
BRISTOL RI
02809-3523
US

V. Phone/Fax

Practice location:
  • Phone: 419-206-0232
  • Fax:
Mailing address:
  • Phone: 419-206-0232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS01935
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS01935
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: