Provider Demographics
NPI:1235307398
Name:UNDIVIDUAL INC
Entity Type:Organization
Organization Name:UNDIVIDUAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MSW, LMHC
Authorized Official - Phone:401-578-8775
Mailing Address - Street 1:1 RICHMOND SQ
Mailing Address - Street 2:SUITE 103K
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5139
Mailing Address - Country:US
Mailing Address - Phone:401-274-8472
Mailing Address - Fax:
Practice Address - Street 1:144 WATERMAN ST STE 1
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2126
Practice Address - Country:US
Practice Address - Phone:401-578-8775
Practice Address - Fax:401-533-9532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00116251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health