Provider Demographics
NPI:1225644784
Name:CERISSA BLANEY PHD LLC
Entity Type:Organization
Organization Name:CERISSA BLANEY PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CERISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:401-236-5222
Mailing Address - Street 1:18 MAPLE AVE # 292
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-3560
Mailing Address - Country:US
Mailing Address - Phone:401-236-5222
Mailing Address - Fax:
Practice Address - Street 1:18 MAPLE AVE # 292
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-3560
Practice Address - Country:US
Practice Address - Phone:401-236-5222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty