Healthcare Provider Details

I. General information

NPI: 1548758444
Provider Name (Legal Business Name): EMILY GATHRIGHT PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date: 04/26/2018
Reactivation Date: 07/23/2024

III. Provider practice location address

146 W RIVER ST STE 11A
PROVIDENCE RI
02904-2609
US

IV. Provider business mailing address

164 SUMMIT AVE
PROVIDENCE RI
02906-2853
US

V. Phone/Fax

Practice location:
  • Phone: 401-606-8250
  • Fax: 401-606-1153
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS01804
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: