Provider Demographics
NPI:1992058580
Name:CENTER FOR INTEGRATED PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:CENTER FOR INTEGRATED PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER AND LICENSED PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RACKLEY-JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:401-294-9323
Mailing Address - Street 1:1130 TEN ROD RD
Mailing Address - Street 2:SUITE D-307A
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-4161
Mailing Address - Country:US
Mailing Address - Phone:401-294-9323
Mailing Address - Fax:401-294-9320
Practice Address - Street 1:1130 TEN ROD RD
Practice Address - Street 2:SUITE D-307A
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4161
Practice Address - Country:US
Practice Address - Phone:401-294-9323
Practice Address - Fax:401-294-9320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW020181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty