Healthcare Provider Details

I. General information

NPI: 1508475880
Provider Name (Legal Business Name): RI THERAPEUTIC ALLIANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 HILLTOP DR
N SCITUATE RI
02857-1215
US

IV. Provider business mailing address

PO BOX 32
WOONSOCKET RI
02895-0779
US

V. Phone/Fax

Practice location:
  • Phone: 401-526-3211
  • Fax:
Mailing address:
  • Phone: 401-526-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SARAH MAILHOT
Title or Position: OWNER
Credential: LICSW
Phone: 401-526-3211