Provider Demographics
NPI:1992173371
Name:PROVIDENCE PARTNERS BEHAVIORAL HEALTHCARE LLP.
Entity type:Organization
Organization Name:PROVIDENCE PARTNERS BEHAVIORAL HEALTHCARE LLP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:AVERSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-383-8349
Mailing Address - Street 1:225 NEWMAN AVE
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-1218
Mailing Address - Country:US
Mailing Address - Phone:401-383-8349
Mailing Address - Fax:401-383-8030
Practice Address - Street 1:225 NEWMAN AVE
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:RI
Practice Address - Zip Code:02916-1218
Practice Address - Country:US
Practice Address - Phone:401-383-8349
Practice Address - Fax:401-383-8030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW01147101Y00000X
RICDP00312101YA0400X
RIMHC00156101YM0800X
RI106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty