Provider Demographics
NPI:1013084128
Name:LOWE, ROSANNE M (PH D)
Entity Type:Individual
Prefix:DR
First Name:ROSANNE
Middle Name:M
Last Name:LOWE
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 JEFFERSON BLVD
Mailing Address - Street 2:SUITE B 105
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1357
Mailing Address - Country:US
Mailing Address - Phone:401-738-6865
Mailing Address - Fax:401-738-1621
Practice Address - Street 1:615 JEFFERSON BLVD
Practice Address - Street 2:SUITE B 105
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1357
Practice Address - Country:US
Practice Address - Phone:401-738-6865
Practice Address - Fax:401-738-1621
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS 194103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPS 194OtherPSYCHOLOGIST LICENSE #
RI3498-4OtherBLUE CROSS PROVIDER #
RI406783OtherBLUE CHIP PROVIDER #