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General NPI Number Information
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NPI Number | 1154348803
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Entity Type | Organization
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Legal Business Name | COLLABORATIVE FOR BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 07/09/2008
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Provider Practice Location Address
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Address Line | 654 METACOM AVE
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City | WARREN
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State | RI
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Zip | 02885-2300
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Country | US
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Telephone | 401-245-5395
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Fax | 401-245-5395
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Provider Business Mailing Address
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Address Line | 34 2ND ST
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City | SWANSEA
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State | MA
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Zip | 02777-3203
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Country | US
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Telephone | 508-324-5282
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Fax | 401-245-5395
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Authorized Official
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Title or Position | CLINCAL DIRECTOR
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Name | MS. DENISE MARIE FRAGOZA
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Credential | MSW,LICSW,LCDP
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Telephone | 401-245-5395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDP00146
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW00719
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License Number State | RI
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