NPI 1558941963 · live from the CMS NPI Registry
Charles Alexander Brake, Ph.D.
Psychologist in Providence, RI. National Provider Identifier 1558941963, active.
NPI record
| NPI | 1558941963 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Psychologist 103T00000X |
| Practice location | 830 Chalkstone Ave Bldg 14, Providence, RI 02908 |
| Practice phone | 401-273-7100 |
| Mailing address | 243 Broadway Apt 3, Providence, RI 02903 |
| Enumerated | April 9, 2021 |
| Last updated | April 9, 2021 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychologist primary | 103T00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.