| Peaceful Mind, Inc. | |
|
120 Wayland Ave Providence RI 02906-4318 | |
| (401) 273-2858 | |
| (843) 667-6687 |
| Full Name | Peaceful Mind, Inc. |
|---|---|
| Speciality | Social Worker |
| Location | 120 Wayland Ave, Providence, Rhode Island |
| Authorized Official Name and Position | Cecilia M Dietzler (OWNER) |
| Authorized Official Contact | 4012732858 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peaceful Mind, Inc. 120 Wayland Ave Providence RI 02906-4318 Ph: (401) 273-2858 | Peaceful Mind, Inc. 120 Wayland Ave Providence RI 02906-4318 Ph: (401) 273-2858 |
| NPI Number | 1942520861 |
|---|---|
| Provider Enumeration Date | 06/02/2010 |
| Last Update Date | 06/02/2010 |
| Medicare PECOS PAC ID | 5991837213 |
|---|---|
| Medicare Enrollment ID | O20100721000553 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942520861 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | ISW00899 (Rhode Island) | Primary |
| Provider Name | Cecilia M Dietzler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801071311 PECOS PAC ID: 4880726108 Enrollment ID: I20100721000591 |
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