Provider Demographics
NPI:1073951448
Name:NORTHEAST CHILD AND ADOLESCENT PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:NORTHEAST CHILD AND ADOLESCENT PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTUGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:401-527-8089
Mailing Address - Street 1:132 OLD RIVER RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1161
Mailing Address - Country:US
Mailing Address - Phone:401-527-8089
Mailing Address - Fax:401-333-3370
Practice Address - Street 1:132 OLD RIVER RD
Practice Address - Street 2:SUITE 205
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1161
Practice Address - Country:US
Practice Address - Phone:401-527-8089
Practice Address - Fax:401-333-3370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01318103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty