| Southcoast Psychology,inc | |
|
154 Waterman Street 3rd Floor West Providence RI 02906 | |
| (401) 241-2059 | |
| Not Available |
| Full Name | Southcoast Psychology,inc |
|---|---|
| Speciality | Psychologist |
| Location | 154 Waterman Street, Providence, Rhode Island |
| Authorized Official Name and Position | Thomas J. Petrouski (PRESIDENT) |
| Authorized Official Contact | 5086441210 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southcoast Psychology,inc P.o. Box 642 Assonet MA 02702-1446 Ph: (508) 644-1210 | Southcoast Psychology,inc 154 Waterman Street 3rd Floor West Providence RI 02906 Ph: (401) 241-2059 |
| NPI Number | 1689886194 |
|---|---|
| Provider Enumeration Date | 05/04/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689886194 | NPI | - | NPPES |
| #SS11558 | Medicaid | RI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PS00719 (Rhode Island) | Primary |
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