=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588925846
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEHAVIORAL HEALTH SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2012
-----------------------------------------------------
Last Update Date | 06/04/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 71 GOVERNOR BRADFORD DR
-----------------------------------------------------
City | BARRINGTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02806-4732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-447-4616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 71 GOVERNOR BRADFORD DR
-----------------------------------------------------
City | BARRINGTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02806-4732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-447-4616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARK C DUMAS
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 401-447-4616
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------