Healthcare Provider Details

I. General information

NPI: 1689618688
Provider Name (Legal Business Name): TERRIE ANNETTE MAILHOT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 LAMBERT LIND HWY QUALITY BEHAVIORAL HEALTH INC
WARWICK RI
02886-1131
US

IV. Provider business mailing address

75 LAMBERT LIND HWY SUITE 120-100
WARWICK RI
02886-1131
US

V. Phone/Fax

Practice location:
  • Phone: 401-681-4274
  • Fax: 401-681-4285
Mailing address:
  • Phone: 401-681-4274
  • Fax: 401-681-4285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD07512
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: