Healthcare Provider Details

I. General information

NPI: 1194166348
Provider Name (Legal Business Name): CONTINUUM BEHAVIORAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RANDALL SQ SUITE 206
PROVIDENCE RI
02904-2709
US

IV. Provider business mailing address

ONE RANDALL SQUARE SUITE 206
PROVIDENCE RI
02904-5757
US

V. Phone/Fax

Practice location:
  • Phone: 401-443-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. DONNA RICHARD
Title or Position: DIRECTOR OF PRACTICE ADMINISTRATION
Credential:
Phone: 401-528-0140