Healthcare Provider Details

I. General information

NPI: 1609159219
Provider Name (Legal Business Name): WELLNESS PSYCHIATRIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 GEORGE WASHINGTON HWY SUITE 400
LINCOLN RI
02865-4330
US

IV. Provider business mailing address

652 GEORGE WASHINGTON HWY SUITE 400
LINCOLN RI
02865-4330
US

V. Phone/Fax

Practice location:
  • Phone: 401-334-1830
  • Fax: 401-334-1833
Mailing address:
  • Phone: 401-334-1830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberDO00622
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberDO00622
License Number StateRI

VIII. Authorized Official

Name: SARAH XAVIER
Title or Position: PSYCHIATRIST
Credential:
Phone: 401-334-1830