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General NPI Number Information
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NPI Number | 1104047687
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Entity Type | Individual
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Provider Name | BEVERLY SERABIAN PHD
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 267 GANO STREET
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City | PROVIDENCE
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State | RI
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Zip | 02906-4025
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Country | US
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Telephone | 401-331-7387
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Fax |
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Provider Business Mailing Address
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Address Line | 267 GANO STREET
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City | PROVIDENCE
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State | RI
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Zip | 02906-4025
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Country | US
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Telephone | 401-331-7387
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS00255
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License Number State | RI
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