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66 Pavilion Ave Providence RI 02905-1522 | |
| (401) 780-2300 | |
| (401) 780-2397 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 66 Pavilion Ave, Providence, Rhode Island |
| Authorized Official Name and Position | Peter Morris (COO) |
| Authorized Official Contact | 4017802300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
66 Pavilion Ave Providence RI 02905-1522 Ph: (401) 780-2300 | 66 Pavilion Ave Providence RI 02905-1522 Ph: (401) 780-2300 |
| NPI Number | 1790991537 |
|---|---|
| Provider Enumeration Date | 05/16/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790991537 | NPI | - | NPPES |
| RI5445 | Medicaid | RI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 608 (Rhode Island) | Primary |
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