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General NPI Number Information
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NPI Number | 1942520861
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Entity Type | Organization
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Legal Business Name | PEACEFUL MIND, INC.
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Dates
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Enumeration Date | 06/02/2010
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Last Update Date | 06/02/2010
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Provider Practice Location Address
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Address Line | 120 WAYLAND AVE
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City | PROVIDENCE
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State | RI
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Zip | 02906-4318
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Country | US
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Telephone | 401-273-2858
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Fax | 843-667-6687
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Provider Business Mailing Address
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Address Line | 120 WAYLAND AVE
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City | PROVIDENCE
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State | RI
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Zip | 02906-4318
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Country | US
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Telephone | 401-273-2858
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Fax | 843-667-6687
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Authorized Official
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Title or Position | OWNER
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Name | CECILIA M DIETZLER
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Credential | LICSW
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Telephone | 401-273-2858
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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 | ISW00899
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License Number State | RI
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