NPI 1790207876 · live from the CMS NPI Registry
Center For Dynamic And Behavioral Therapy LLC
Psychologist, Clinical in Providence, RI. National Provider Identifier 1790207876, active.
NPI record
| NPI | 1790207876 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Psychologist, Clinical 103TC0700X |
| Practice location | 382 Thayer St, Providence, RI 02906 |
| Practice phone | 401-330-5882 |
| Mailing address | 11 S Angell St # 405, Providence, RI 02906 |
| Enumerated | July 11, 2017 |
| Last updated | July 25, 2021 |
| Authorized official | Nicole Issa, Owner |
| Other names | Pvd Psychological Associates |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychologist, Clinical | 103TC0700X | PS01615 (RI) |
| Psychologist, Clinical primary | 103TC0700X | PS01616 (RI) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.