=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902085467
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREATER RI ADDICTION SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2007
-----------------------------------------------------
Last Update Date | 10/31/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1704 BROAD ST
-----------------------------------------------------
City | CRANSTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02905-2720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-461-5555
-----------------------------------------------------
Fax | 401-461-5599
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1704 BROAD ST
-----------------------------------------------------
City | CRANSTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02905-2720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-461-5555
-----------------------------------------------------
Fax | 401-461-5599
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADDICTIONS COUNSELOR
-----------------------------------------------------
Name | MS. KAREN E. MAINE
-----------------------------------------------------
Credential | BS,LCDP,RCS
-----------------------------------------------------
Telephone | 401-461-5555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | LCDP00390
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------