| Tides Of Mind Counseling Of Rhode Island | |
|
245 Waterman St Ste 200 Providence RI 02906-5215 | |
| (401) 369-8192 | |
| Not Available |
| Full Name | Tides Of Mind Counseling Of Rhode Island |
|---|---|
| Speciality | Psychologist |
| Location | 245 Waterman St Ste 200, Providence, Rhode Island |
| Authorized Official Name and Position | Amanda Bronson (CEO) |
| Authorized Official Contact | 7045066267 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tides Of Mind Counseling Of Rhode Island 67 Burnside Ave East Hartford CT 06108-3408 Ph: (952) 246-4564 | Tides Of Mind Counseling Of Rhode Island 245 Waterman St Ste 200 Providence RI 02906-5215 Ph: (401) 369-8192 |
| NPI Number | 1003688037 |
|---|---|
| Provider Enumeration Date | 10/24/2023 |
| Last Update Date | 12/07/2023 |
| Certification Date | 12/07/2023 |
| Medicare PECOS PAC ID | 9436502879 |
|---|---|
| Medicare Enrollment ID | O20240313001329 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003688037 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Primary |
| Provider Name | Sarah A Ostrom |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922245620 PECOS PAC ID: 2860740750 Enrollment ID: I20180809000790 |
| Provider Name | Samuel Wallace Peloquin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154069045 PECOS PAC ID: 3870957723 Enrollment ID: I20230912001378 |
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