Provider Demographics
NPI:1992056758
Name:COMPASS ROSE PSYCHIATRY, LLC
Entity type:Organization
Organization Name:COMPASS ROSE PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ARLENE
Authorized Official - Last Name:BUCK-HERDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RN, PMHCNS-BC
Authorized Official - Phone:401-293-5930
Mailing Address - Street 1:107 CLOCK TOWER SQ
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-1396
Mailing Address - Country:US
Mailing Address - Phone:401-293-5930
Mailing Address - Fax:401-293-0097
Practice Address - Street 1:107 CLOCK TOWER SQ
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-1396
Practice Address - Country:US
Practice Address - Phone:401-293-5930
Practice Address - Fax:401-293-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPPNS00075364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty