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General NPI Number Information
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NPI Number | 1225334881
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Entity Type | Organization
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Legal Business Name | BAYSIDE COUNSELING, LLC
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Dates
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Enumeration Date | 01/31/2011
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Last Update Date | 02/04/2011
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Provider Practice Location Address
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Address Line | 110 MAIN ST SUITE 202
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City | EAST GREENWICH
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State | RI
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Zip | 02818-4072
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Country | US
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Telephone | 401-263-3003
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Fax |
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Provider Business Mailing Address
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Address Line | 110 MAIN ST SUITE 202
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City | EAST GREENWICH
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State | RI
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Zip | 02818-4072
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | ELIZABETH ANN FEISTHAMEL
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Credential | LICSW
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Telephone | 401-263-3003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | ISW01171
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License Number State | RI
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