Healthcare Provider Details

I. General information

NPI: 1306457155
Provider Name (Legal Business Name): LAURIE BETH ATKINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 PARK AVE
CRANSTON RI
02910-2165
US

IV. Provider business mailing address

628 PARK AVE
CRANSTON RI
02910-2165
US

V. Phone/Fax

Practice location:
  • Phone: 401-228-8303
  • Fax:
Mailing address:
  • Phone: 401-228-8303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA00297
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: