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General NPI Number Information
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NPI Number | 1861944969
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Entity Type | Organization
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Legal Business Name | INNOVATIVE THERAPEUTICS OF RHODE ISLAND LLC
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Dates
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Enumeration Date | 10/25/2016
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Last Update Date | 10/25/2016
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Provider Practice Location Address
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Address Line | 316 WILLETT AVE
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City | RIVERSIDE
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State | RI
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Zip | 02915-2511
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Country | US
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Telephone | 401-270-2468
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Fax | 781-964-9446
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Provider Business Mailing Address
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Address Line | 316 WILLETT AVE
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City | RIVERSIDE
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State | RI
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Zip | 02915-2511
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Country | US
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Telephone | 401-270-2468
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Fax | 781-964-9446
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Authorized Official
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Title or Position | OWNER
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Name | MS. WENDY CARLSON
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Credential | PMHNP-BC
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Telephone | 781-964-9446
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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 | APRN01440
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License Number State | RI
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