Provider Demographics
NPI:1861408056
Name:EDWARDS, GWENYTH HUGHES (PHD)
Entity type:Individual
Prefix:
First Name:GWENYTH
Middle Name:HUGHES
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 LAUREL LANE
Mailing Address - Street 2:
Mailing Address - City:WEST KINGSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02892
Mailing Address - Country:US
Mailing Address - Phone:401-792-8326
Mailing Address - Fax:401-789-3748
Practice Address - Street 1:24 SALT POND ROAD
Practice Address - Street 2:SUITE D-4
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879
Practice Address - Country:US
Practice Address - Phone:401-789-3694
Practice Address - Fax:401-789-3748
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI762103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI409076OtherRI BLUE CHIP
RIGE21595Medicaid
RI239118OtherRI BLUE CROSS
RI6179269OtherUHPNE