Provider Demographics
NPI:1558347997
Name:TRASK, CHRISTINE LOUISE (PHD, ABPP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LOUISE
Last Name:TRASK
Suffix:
Gender:F
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 LAUREL RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-4147
Mailing Address - Country:US
Mailing Address - Phone:401-529-8049
Mailing Address - Fax:
Practice Address - Street 1:1130 TEN ROD ROAD
Practice Address - Street 2:BLDG. E, SUITE 101
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852
Practice Address - Country:US
Practice Address - Phone:401-294-6900
Practice Address - Fax:401-294-6690
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00835103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical