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General NPI Number Information
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NPI Number | 1225820442
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Entity Type | Organization
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Legal Business Name | BRAINWISE
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Dates
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Enumeration Date | 05/22/2025
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 1275 WAMPANOAG TRL STE 9
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City | RIVERSIDE
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State | RI
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Zip | 02915-1217
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Country | US
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Telephone | 401-352-8440
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Fax |
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Provider Business Mailing Address
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Address Line | 1275 WAMPANOAG TRL STE 9
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City | RIVERSIDE
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State | RI
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Zip | 02915-1217
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Country | US
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Telephone | 401-352-8440
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Fax | 401-355-3655
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Authorized Official
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Title or Position | BILLER
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Name | ASHLEY LETENDRE
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Credential |
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Telephone | 401-812-5134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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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Taxonomy #3
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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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 #5
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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