Healthcare Provider Details

I. General information

NPI: 1821256140
Provider Name (Legal Business Name): INTEGRATED PSYCHIATRY INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

663 ATWOOD AVE
CRANSTON RI
02920-5322
US

IV. Provider business mailing address

75 NEWMAN AVE SUITE 100
RUMFORD RI
02916-1945
US

V. Phone/Fax

Practice location:
  • Phone: 401-277-9992
  • Fax:
Mailing address:
  • Phone: 401-453-0666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number9216
License Number StateRI

VIII. Authorized Official

Name: MARIA GONZALEZ
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 401-277-9992