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General NPI Number Information
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NPI Number | 1851098479
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Entity Type | Organization
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Legal Business Name | OPAL BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 02/14/2023
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Last Update Date | 04/05/2023
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Provider Practice Location Address
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Address Line | 383 W FOUNTAIN ST STE 103
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City | PROVIDENCE
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State | RI
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Zip | 02903-3515
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Country | US
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Telephone | 401-217-9377
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Fax | 401-200-3166
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Provider Business Mailing Address
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Address Line | 3 RINGGOLD ST
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City | PROVIDENCE
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State | RI
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Zip | 02903-1432
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Country | US
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Telephone | 401-217-9377
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Fax | 401-200-3166
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Authorized Official
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Title or Position | OWNER
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Name | SUSANNA DRAIGHAN
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Credential | APRN
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Telephone | 401-217-9377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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