Provider Demographics
NPI:1942367412
Name:MIECZYNSKI, NATALIA DUKE (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:NATALIA
Middle Name:DUKE
Last Name:MIECZYNSKI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:NATALIA
Other - Middle Name:SENNA
Other - Last Name:DUKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1011 VETERAN MEMORIAL PARKWAY
Mailing Address - Street 2:ADOLESCENT INPATIENT UNIT, BRADLEY HOSPITAL
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-5061
Mailing Address - Country:US
Mailing Address - Phone:401-432-1000
Mailing Address - Fax:401-432-1500
Practice Address - Street 1:1011 VETERANS MEMORIAL PARKWAY
Practice Address - Street 2:EMMA PENDLETON BRADLEY HOSPITAL
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02915-5061
Practice Address - Country:US
Practice Address - Phone:401-432-1000
Practice Address - Fax:401-432-1500
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01153103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPS01153OtherPROFESSIONAL LICENSE