Healthcare Provider Details

I. General information

NPI: 1225398290
Provider Name (Legal Business Name): SMGRI, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 CASS AVE
WOONSOCKET RI
02895-4712
US

IV. Provider business mailing address

500 BOYLSTON ST
BOSTON MA
02116-3740
US

V. Phone/Fax

Practice location:
  • Phone: 401-767-1581
  • Fax:
Mailing address:
  • Phone: 617-419-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH CARROZZA
Title or Position: CHIEF
Credential: MD
Phone: 617-789-5027