Healthcare Provider Details

I. General information

NPI: 1174486211
Provider Name (Legal Business Name): WILD ROSE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MAPLE ST STE 200
PAWTUCKET RI
02860-2104
US

IV. Provider business mailing address

25 MAPLE ST SUITE 200 #1057
PAWTUCKET RI
02860-2104
US

V. Phone/Fax

Practice location:
  • Phone: 401-358-1050
  • Fax:
Mailing address:
  • Phone: 401-358-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CLAIRE ROBINSON
Title or Position: OWNER
Credential: LICSW
Phone: 810-923-5424