Provider Demographics
NPI:1376952317
Name:REID, JESSICA GRACE
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:GRACE
Last Name:REID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BALD HILL RD STE 530
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-6111
Mailing Address - Country:US
Mailing Address - Phone:013-493-1314
Mailing Address - Fax:
Practice Address - Street 1:400 BALD HILL RD STE 530
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-6111
Practice Address - Country:US
Practice Address - Phone:401-349-3131
Practice Address - Fax:401-921-5109
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01877103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical