Healthcare Provider Details

I. General information

NPI: 1649783044
Provider Name (Legal Business Name): ANDREW N GOINS M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 HARMONY HILL RD
CHEPACHET RI
02814-1429
US

IV. Provider business mailing address

13 PEZZULLO ST APT 1
JOHNSTON RI
02919-6295
US

V. Phone/Fax

Practice location:
  • Phone: 401-949-0690
  • Fax: 401-949-4412
Mailing address:
  • Phone: 401-297-6887
  • Fax: 401-949-4412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: