Healthcare Provider Details

I. General information

NPI: 1558347997
Provider Name (Legal Business Name): CHRISTINE LOUISE TRASK PHD, ABPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 TEN ROD ROAD BLDG. E, SUITE 101
NORTH KINGSTOWN RI
02852
US

IV. Provider business mailing address

94 LAUREL RIDGE LN
NORTH KINGSTOWN RI
02852-4147
US

V. Phone/Fax

Practice location:
  • Phone: 401-294-6900
  • Fax: 401-294-6690
Mailing address:
  • Phone: 401-529-8049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS00835
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS00835
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: