Provider Demographics
NPI:1285652941
Name:BUCK-HERDRICH, SARAH ARLENE (MS RN PMHCNS-BC)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ARLENE
Last Name:BUCK-HERDRICH
Suffix:
Gender:F
Credentials:MS RN PMHCNS-BC
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:ARLENE
Other - Last Name:BUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS RN PCNS
Mailing Address - Street 1:107 CLOCK TOWER SQ
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-1396
Mailing Address - Country:US
Mailing Address - Phone:401-293-5930
Mailing Address - Fax:401-293-0097
Practice Address - Street 1:107 CLOCK TOWER SQ
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-1396
Practice Address - Country:US
Practice Address - Phone:401-293-5930
Practice Address - Fax:401-293-0097
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPPNS00075363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0000041302OtherBLUE CHIP
RI0000031092OtherBLUE CROSS
RISB42521Medicaid
RISB42521Medicaid