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General NPI Number Information
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NPI Number | 1992058580
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Entity Type | Organization
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Legal Business Name | CENTER FOR INTEGRATED PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 10/19/2012
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Last Update Date | 10/19/2012
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Provider Practice Location Address
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Address Line | 1130 TEN ROD RD SUITE D-307A
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852-4161
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Country | US
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Telephone | 401-294-9323
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Fax | 401-294-9320
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Provider Business Mailing Address
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Address Line | 1130 TEN ROD RD SUITE D-307A
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852-4161
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Country | US
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Telephone | 401-294-9323
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Fax | 401-294-9320
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Authorized Official
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Title or Position | MEMBER AND LICENSED PSYCHOTHERAPIST
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Name | LAURIE RACKLEY-JOSEPH
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Credential | LICSW
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Telephone | 401-294-9323
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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 | ISW02018
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License Number State | RI
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