Healthcare Provider Details

I. General information

NPI: 1366984205
Provider Name (Legal Business Name): RAWYA ALJABARI PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST POTTER 2
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

117 ELLENFIELD ST SUITE 101
PROVIDENCE RI
02905-4513
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-2128
  • Fax: 401-444-8836
Mailing address:
  • Phone: 401-444-6779
  • Fax: 401-444-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS01597
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: