Healthcare Provider Details

I. General information

NPI: 1245695964
Provider Name (Legal Business Name): PETITPAS PSYCHIATRIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 RESERVOIR AVE STE.2
CRANSTON RI
02910-4453
US

IV. Provider business mailing address

900 RESERVOIR AVE STE.2
CRANSTON RI
02910-4453
US

V. Phone/Fax

Practice location:
  • Phone: 401-944-0194
  • Fax: 401-944-0196
Mailing address:
  • Phone: 401-944-0194
  • Fax: 401-944-0196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberPCNS00064
License Number StateRI

VIII. Authorized Official

Name: MRS. PATRICIA A PETITPAS
Title or Position: OWNER
Credential: APRN/PCNS
Phone: 401-944-0194