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General NPI Number Information
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NPI Number | 1992173371
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Entity Type | Organization
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Legal Business Name | PROVIDENCE PARTNERS BEHAVIORAL HEALTHCARE LLP.
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Dates
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Enumeration Date | 09/02/2015
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Last Update Date | 09/21/2015
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Provider Practice Location Address
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Address Line | 225 NEWMAN AVE
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City | RUMFORD
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State | RI
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Zip | 02916-1218
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Country | US
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Telephone | 401-383-8349
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Fax | 401-383-8030
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Provider Business Mailing Address
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Address Line | 225 NEWMAN AVE
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City | RUMFORD
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State | RI
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Zip | 02916-1218
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Country | US
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Telephone | 401-383-8349
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Fax | 401-383-8030
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Authorized Official
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Title or Position | ADMINISTRATIVE MANAGER
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Name | MS. KAREN MARIE AVERSA
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Credential |
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Telephone | 401-383-8349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | ISW01147
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDP00312
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License Number State | RI
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MHC00156
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License Number State | RI
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