Healthcare Provider Details

I. General information

NPI: 1982703799
Provider Name (Legal Business Name): JACQUELINE ANNE TWITCHELL PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACKIE ANNE TWITCHELL PSYD

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RICHMOND SQ STE 321W
PROVIDENCE RI
02906
US

IV. Provider business mailing address

15 BRIARWOOD RD
NORTH SCITUATE RI
02857-2806
US

V. Phone/Fax

Practice location:
  • Phone: 239-770-4255
  • Fax:
Mailing address:
  • Phone: 239-770-4255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS01294
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: