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General NPI Number Information
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NPI Number | 1104713536
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Entity Type | Organization
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Legal Business Name | STILL WATERS PSYCHIATRY, LLC
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Dates
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Enumeration Date | 06/19/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 197 WARREN AVE STE 101
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City | EAST PROVIDENCE
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State | RI
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Zip | 02914-4826
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Country | US
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Telephone | 401-238-0776
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Fax | 401-757-8688
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Provider Business Mailing Address
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Address Line | 197 WARREN AVE STE 101
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City | EAST PROVIDENCE
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State | RI
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Zip | 02914-4826
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Country | US
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Telephone | 401-238-0776
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Fax | 401-757-8688
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Authorized Official
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Title or Position | OWNER
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Name | EMILY DANIELL
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Credential | NP
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Telephone | 251-533-1424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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