Healthcare Provider Details

I. General information

NPI: 1295914257
Provider Name (Legal Business Name): LAUREN DALE GREVE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 JEFFERSON BLVD SUITE 2009
WARWICK RI
02886-2234
US

IV. Provider business mailing address

931 JEFFERSON BLVD SUITE 2009
WARWICK RI
02886-2234
US

V. Phone/Fax

Practice location:
  • Phone: 401-921-5400
  • Fax: 401-921-5402
Mailing address:
  • Phone: 401-921-5400
  • Fax: 401-921-5402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS01050
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: