| Groden Center, Inc | |
|
86 Mount Hope Ave Providence RI 02906-1648 | |
| (401) 274-6310 | |
| (401) 421-1077 |
| Full Name | Groden Center, Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 86 Mount Hope Ave, Providence, Rhode Island |
| Authorized Official Name and Position | Grace Toe (CFO) |
| Authorized Official Contact | 4012746310 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Groden Center, Inc 610 Manton Ave Providence RI 02909-5633 Ph: (401) 274-6310 | Groden Center, Inc 86 Mount Hope Ave Providence RI 02906-1648 Ph: (401) 274-6310 |
| NPI Number | 1336297902 |
|---|---|
| Provider Enumeration Date | 01/08/2007 |
| Last Update Date | 11/20/2023 |
| Certification Date | 11/20/2023 |
| Medicare PECOS PAC ID | 6204029093 |
|---|---|
| Medicare Enrollment ID | O20101025001371 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336297902 | NPI | - | NPPES |
| GC 02406 | Medicaid | RI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Kelley H Pistacchio |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1780713735 PECOS PAC ID: 6901099795 Enrollment ID: I20101026000473 |
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