Provider Demographics
NPI:1912201682
Name:MARIA EGUIA-BRUSCO, PH.D LTD.
Entity Type:Organization
Organization Name:MARIA EGUIA-BRUSCO, PH.D LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:EUGENIA
Authorized Official - Last Name:EGUIA-BRUSCO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:401-921-5400
Mailing Address - Street 1:11 ALHAMBRA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02905
Mailing Address - Country:US
Mailing Address - Phone:401-921-5400
Mailing Address - Fax:401-921-5402
Practice Address - Street 1:1130 TEN ROD RD.
Practice Address - Street 2:SUITE E101
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852
Practice Address - Country:US
Practice Address - Phone:401-921-5400
Practice Address - Fax:401-921-5402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00699103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty