Provider Demographics
NPI:1427237502
Name:NEWPORT PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:NEWPORT PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEURANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-619-2144
Mailing Address - Street 1:227 W MAIN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-4900
Mailing Address - Country:US
Mailing Address - Phone:401-619-2144
Mailing Address - Fax:401-619-0323
Practice Address - Street 1:227 W MAIN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-4900
Practice Address - Country:US
Practice Address - Phone:401-619-2144
Practice Address - Fax:401-619-0323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMT00061106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI25584OtherBC/BS OF RI