=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437210044
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEWPORT COUNTY COMMUNITY MENTAL HEALTH CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 127 JOHNNY CAKE HILL RD
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02842-5674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-846-1214
-----------------------------------------------------
Fax | 401-324-6251
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 127 JOHNNY CAKE HILL RD
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02842-5674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-846-1214
-----------------------------------------------------
Fax | 401-324-6251
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM COORDINATOR, HUMAN RESOURCE
-----------------------------------------------------
Name | MRS. MIRIAM J BARTLETT
-----------------------------------------------------
Credential | BA
-----------------------------------------------------
Telephone | 401-846-1213
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | LCDP00296
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------