| Ship | |
|
10 Davol Sq Ste 100 Providence RI 02903-4752 | |
| (401) 489-5513 | |
| Not Available |
| Full Name | Ship |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 10 Davol Sq Ste 100, Providence, Rhode Island |
| Authorized Official Name and Position | Alicia Gauvin (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4014895513 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ship 10 Davol Sq C/o The Seg Hub, Suite 100 Providence RI 02903-4752 Ph: (401) 489-5513 | Ship 10 Davol Sq Ste 100 Providence RI 02903-4752 Ph: (401) 489-5513 |
| NPI Number | 1316418874 |
|---|---|
| Provider Enumeration Date | 12/10/2018 |
| Last Update Date | 01/13/2023 |
| Certification Date | 01/13/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316418874 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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