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General NPI Number Information
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NPI Number | 1932626231
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Entity Type | Organization
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Legal Business Name | CHILD SPECIALTY SERVICES LLC
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Dates
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Enumeration Date | 08/28/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 11 KING CHARLES DR # 4B
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City | PORTSMOUTH
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State | RI
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Zip | 02871-1446
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Country | US
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Telephone | 401-626-6165
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Fax |
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Provider Business Mailing Address
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Address Line | 11 KING CHARLES DR # 4B
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City | PORTSMOUTH
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State | RI
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Zip | 02871-1446
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Country | US
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Telephone | 401-626-6165
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARCY ATKINS
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Credential | PSY. D
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Telephone | 401-626-6165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS00901
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License Number State | RI
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