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80 Washington St 303 Providence RI 02903-1819 | |
| (401) 277-5180 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 80 Washington St, Providence, Rhode Island |
| Authorized Official Name and Position | John O'leary (DIRECTOR OF SPECIAL PROGRAMS) |
| Authorized Official Contact | 4012775054 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
80 Washington St 303 Providence RI 02903-1819 Ph: (401) 277-5180 | 80 Washington St 303 Providence RI 02903-1819 Ph: (401) 277-5180 |
| NPI Number | 1023471356 |
|---|---|
| Provider Enumeration Date | 04/04/2016 |
| Last Update Date | 04/04/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023471356 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 7510 (Massachusetts) | Primary |
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