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NPI Code Detail

MEDICARE: BRYANA FC WHITE MA PYSCH

MEDICARE: BRYANA FC WHITE MA PYSCH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2103TC0700XClinical PsychologistPS02149RI

General Provider Information

NPI Number : 1295014967
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRYANA FC WHITE MA PYSCH
Provider Business Mailing Address
First Line : 25 ROBERTS CT
Second Line :
City : KINGSTON
State : RI
Zip : 02881-1792
Country : US
Telephone Number : 508-472-6391
Fax Number :
Provider Business Practice Location Address
First Line : 1130 TEN ROD RD STE E305
Second Line :
City : NORTH KINGSTOWN
State : RI
Zip : 02852-4176
Country : US
Telephone Number : 401-294-0451
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2011
Last Update Date : 05/01/2024

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Directions to “ BRYANA FC WHITE MA PYSCH” Practice Location

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