Provider Demographics
NPI:1215207105
Name:KARYNE B WILNER
Entity Type:Organization
Organization Name:KARYNE B WILNER
Other - Org Name:INTEGRATED PSYCHOLOGICAL SERVICES CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KARYNE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILNER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:401-316-7041
Mailing Address - Street 1:116 GIDEON LAWTON LN
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-4049
Mailing Address - Country:US
Mailing Address - Phone:401-316-7041
Mailing Address - Fax:401-751-8997
Practice Address - Street 1:182 BUTLER AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5317
Practice Address - Country:US
Practice Address - Phone:401-316-7041
Practice Address - Fax:401-751-8997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00923103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI421649Medicare PIN