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General NPI Number Information
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NPI Number | 1568156180
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Entity Type | Individual
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Provider Name | CROSBY ALYSE MODROWSKI PHD
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Gender | Female
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Dates
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Enumeration Date | 06/06/2023
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 495 HOPE ST
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City | BRISTOL
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State | RI
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Zip | 02809-1848
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Country | US
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Telephone | 419-206-0232
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Fax |
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Provider Business Mailing Address
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Address Line | 57 MOUNT HOPE AVE
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City | BRISTOL
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State | RI
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Zip | 02809-3523
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Country | US
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Telephone | 419-206-0232
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PS01935
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS01935
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License Number State | RI
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