Provider Demographics
NPI:1588602692
Name:GUEVREMONT, DAVID CHARLES (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CHARLES
Last Name:GUEVREMONT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 CUMBERLAND ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-3323
Mailing Address - Country:US
Mailing Address - Phone:401-356-1940
Mailing Address - Fax:401-356-1949
Practice Address - Street 1:68 CUMBERLAND ST
Practice Address - Street 2:SUITE 102
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3323
Practice Address - Country:US
Practice Address - Phone:401-356-1940
Practice Address - Fax:401-356-1949
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00517103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI467909OtherTUFTS
RI292748OtherBLUE CROSS BLUE SHIELD
RI412291OtherBLUE CHIP
RI6126902OtherUNITED HEALTH CARE
RIDG03637Medicaid