Healthcare Provider Details

I. General information

NPI: 1720264930
Provider Name (Legal Business Name): PSYCHOTHERAPY SERVICES OF RI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 SOCIAL ST SUITE 590
WOONSOCKET RI
02895-3240
US

IV. Provider business mailing address

191 SOCIAL ST SUITE 590
WOONSOCKET RI
02895-3240
US

V. Phone/Fax

Practice location:
  • Phone: 401-769-4373
  • Fax:
Mailing address:
  • Phone: 401-769-4373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1041C0700X
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number1041S0200X
License Number StateRI

VIII. Authorized Official

Name: MRS. SHERYL LE REEDY
Title or Position: PRESIDENT
Credential: MSW, LICSW
Phone: 401-769-4373