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General NPI Number Information
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NPI Number | 1912201682
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Entity Type | Organization
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Legal Business Name | MARIA EGUIA-BRUSCO, PH.D LTD.
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 07/02/2014
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Provider Practice Location Address
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Address Line | 1130 TEN ROD RD. SUITE E101
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852
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Country | US
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Telephone | 401-921-5400
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Fax | 401-921-5402
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Provider Business Mailing Address
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Address Line | 11 ALHAMBRA CIRCLE
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City | CRANSTON
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State | RI
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Zip | 02905
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Country | US
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Telephone | 401-921-5400
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Fax | 401-921-5402
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIA EUGENIA EGUIA-BRUSCO
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Credential | PHD
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Telephone | 401-921-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS00699
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License Number State | RI
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