Provider Demographics
NPI:1982859997
Name:BLACKSTONE VALLEY FAMILY THERAPY, LTD.
Entity Type:Organization
Organization Name:BLACKSTONE VALLEY FAMILY THERAPY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:INGLE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:401-475-5500
Mailing Address - Street 1:PO BOX 7683
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-0897
Mailing Address - Country:US
Mailing Address - Phone:401-475-5500
Mailing Address - Fax:401-475-5549
Practice Address - Street 1:2190 MENDON RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-3805
Practice Address - Country:US
Practice Address - Phone:401-475-5500
Practice Address - Fax:401-475-5549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty