Provider Demographics
NPI:1215540042
Name:NORTH ROAD PSYCHIATRY LLC
Entity Type:Organization
Organization Name:NORTH ROAD PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:MAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:401-447-1777
Mailing Address - Street 1:23 NORTH RD STE A11
Mailing Address - Street 2:
Mailing Address - City:PEACE DALE
Mailing Address - State:RI
Mailing Address - Zip Code:02879-8108
Mailing Address - Country:US
Mailing Address - Phone:401-447-1777
Mailing Address - Fax:
Practice Address - Street 1:23 NORTH RD STE A11
Practice Address - Street 2:
Practice Address - City:PEACE DALE
Practice Address - State:RI
Practice Address - Zip Code:02879-8108
Practice Address - Country:US
Practice Address - Phone:401-447-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty