Healthcare Provider Details

I. General information

NPI: 1841553724
Provider Name (Legal Business Name): LAURA GRACE WARD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA GRACE ROLLINS PHD

II. Dates (important events)

Enumeration Date: 06/16/2012
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 W RIVER ST STE 8
PROVIDENCE RI
02904-2615
US

IV. Provider business mailing address

117 ELLENFIELD ST STE 101
PROVIDENCE RI
02905-4541
US

V. Phone/Fax

Practice location:
  • Phone: 401-606-3000
  • Fax:
Mailing address:
  • Phone: 401-444-6779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS01938
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: