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General NPI Number Information
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NPI Number | 1942310529
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Entity Type | Organization
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Legal Business Name | COMPEVAL AND TREATMENT SERVICES LLC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 09/03/2010
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Provider Practice Location Address
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Address Line | 3657 POST RD
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City | WARWICK
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State | RI
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Zip | 02886-7238
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Country | US
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Telephone | 401-284-1522
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Fax | 401-284-2515
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Provider Business Mailing Address
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Address Line | 3657 POST RD
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City | WARWICK
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State | RI
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Zip | 02886-7238
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Country | US
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Telephone | 401-284-1522
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Fax | 401-284-2515
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. KEITH F BAGLEY
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Credential | MSW, LICSW, ACSW
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Telephone | 401-284-1522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW00108
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License Number State | RI
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