Healthcare Provider Details

I. General information

NPI: 1578859179
Provider Name (Legal Business Name): WHITMARSH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N MAIN ST
PROVIDENCE RI
02904-5718
US

IV. Provider business mailing address

1055 N MAIN ST
PROVIDENCE RI
02904-5718
US

V. Phone/Fax

Practice location:
  • Phone: 401-351-7230
  • Fax: 401-421-0198
Mailing address:
  • Phone: 401-351-7230
  • Fax: 401-421-0198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number404
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ROBERT M LAROCCO
Title or Position: CEO
Credential: LMFT
Phone: 401-351-7230