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General NPI Number Information
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NPI Number | 1114277985
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Entity Type | Individual
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Provider Name | JANE METRIK PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 142 ROOSEVELT AVE
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City | NORWOOD
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State | MA
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Zip | 02062-3604
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Country | US
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Telephone | 401-863-6650
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Fax |
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Provider Business Mailing Address
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Address Line | BOX G-S121-4 CENTER FOR ALCOHOL AND ADDICTION STUDIES, BROWN UNIVERS
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City | PROVIDENCE
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State | RI
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Zip | 02912
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Country | US
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Telephone | 401-863-6650
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS01010
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License Number State | RI
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