Healthcare Provider Details

I. General information

NPI: 1770698011
Provider Name (Legal Business Name): ST. MARY'S HOME FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 FRUIT HILL AVE
NORTH PROVIDENCE RI
02911-2626
US

IV. Provider business mailing address

420 FRUIT HILL AVE
NORTH PROVIDENCE RI
02911-2626
US

V. Phone/Fax

Practice location:
  • Phone: 401-353-3900
  • Fax: 401-354-7986
Mailing address:
  • Phone: 401-353-3900
  • Fax: 401-354-7986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: BERNARD J. SMITH
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 401-353-3900