Healthcare Provider Details

I. General information

NPI: 1215166996
Provider Name (Legal Business Name): JODY ANN EYRE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 VILLAGE SQUARE DR STE 302
SOUTH KINGSTOWN RI
02879-2569
US

IV. Provider business mailing address

610 TEN ROD RD UNIT 10
NORTH KINGSTOWN RI
02852-4236
US

V. Phone/Fax

Practice location:
  • Phone: 401-785-0040
  • Fax: 401-941-7847
Mailing address:
  • Phone: 401-331-1350
  • Fax: 401-277-3366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT00126
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: