Provider Demographics
NPI:1548388085
Name:GIRLS AND BOYS TOWN OF NEW ENGLAND
Entity Type:Organization
Organization Name:GIRLS AND BOYS TOWN OF NEW ENGLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:REARDON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:401-683-9870
Mailing Address - Street 1:31 KING CHARLES DR STE A
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-1365
Mailing Address - Country:US
Mailing Address - Phone:401-683-9870
Mailing Address - Fax:
Practice Address - Street 1:31 KING CHARLES DR STE A
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-1365
Practice Address - Country:US
Practice Address - Phone:401-683-9870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI11475218251S00000X
RI45920322D00000X
RI46885322D00000X
RI47109322D00000X
RI48180322D00000X
RI48222322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Not Answered322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children