Provider Demographics
NPI:1851333298
Name:GEREMIA, GINA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:M
Last Name:GEREMIA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 KINGSWOOD RD
Mailing Address - Street 2:
Mailing Address - City:N. KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852
Mailing Address - Country:US
Mailing Address - Phone:401-305-2702
Mailing Address - Fax:
Practice Address - Street 1:631 MAIN ST,
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818
Practice Address - Country:US
Practice Address - Phone:401-305-2702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00653103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI407670OtherBLUE CHIP OF RI
RI7889-4OtherBLUE CROSS OF RI