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General NPI Number Information
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NPI Number | 1982859997
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Entity Type | Organization
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Legal Business Name | BLACKSTONE VALLEY FAMILY THERAPY, LTD.
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Dates
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Enumeration Date | 11/19/2008
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Last Update Date | 01/06/2009
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Provider Practice Location Address
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Address Line | 2190 MENDON RD SUITE 3
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City | CUMBERLAND
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State | RI
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Zip | 02864-3805
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Country | US
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Telephone | 401-475-5500
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Fax | 401-475-5549
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Provider Business Mailing Address
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Address Line | PO BOX 7683
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City | CUMBERLAND
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State | RI
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Zip | 02864-0897
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Country | US
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Telephone | 401-475-5500
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Fax | 401-475-5549
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID INGLE
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Credential | PSY.D.
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Telephone | 401-475-5500
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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 |
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License Number State |
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