Provider Demographics
NPI:1467189217
Name:ELEVATE PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:ELEVATE PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BOGS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:401-626-5334
Mailing Address - Street 1:147 BLUEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-2615
Mailing Address - Country:US
Mailing Address - Phone:401-626-5334
Mailing Address - Fax:
Practice Address - Street 1:58 MAIN ST STE 303
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3888
Practice Address - Country:US
Practice Address - Phone:401-626-5334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1043385081Medicaid