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General NPI Number Information
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NPI Number | 1689445884
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Entity Type | Organization
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Legal Business Name | EAST RIVER PSYCHIATRY
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Dates
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Enumeration Date | 01/16/2024
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 105 WESTWOOD CMN
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City | BLUEFIELD
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State | VA
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Zip | 24605-2031
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Country | US
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Telephone | 276-235-6232
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Fax | 276-250-5117
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Provider Business Mailing Address
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Address Line | 105 WESTWOOD CMN
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City | BLUEFIELD
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State | VA
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Zip | 24605-2031
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Country | US
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Telephone | 276-235-6232
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Fax | 276-250-5117
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Authorized Official
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Title or Position | EMPLOYEE
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Name | HOLLY DISIBBIO
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Credential | NP
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Telephone | 301-904-3804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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