Healthcare Provider Details

I. General information

NPI: 1437299955
Provider Name (Legal Business Name): NELLY E BURDETTE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NELLY FREYDIN

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BROAD ST
CENTRAL FALLS RI
02863-1507
US

IV. Provider business mailing address

960 MASSACHUSETTS AVE FL 2
BOSTON MA
02118
US

V. Phone/Fax

Practice location:
  • Phone: 401-722-0081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPS01093
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8669
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: