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General NPI Number Information
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NPI Number | 1316418874
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Entity Type | Organization
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Legal Business Name | SHIP
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Dates
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Enumeration Date | 12/10/2018
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Last Update Date | 01/13/2023
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Provider Practice Location Address
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Address Line | 10 DAVOL SQ STE 100
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City | PROVIDENCE
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State | RI
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Zip | 02903-4752
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Country | US
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Telephone | 401-489-5513
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Fax |
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Provider Business Mailing Address
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Address Line | 10 DAVOL SQ C/O THE SEG HUB, SUITE 100
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City | PROVIDENCE
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State | RI
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Zip | 02903-4752
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Country | US
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Telephone | 401-489-5513
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ALICIA GAUVIN
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Credential |
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Telephone | 401-489-5513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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