Provider Demographics
NPI:1023173499
Name:PSYCHOLOGICAL SUPPORT SERVICES
Entity type:Organization
Organization Name:PSYCHOLOGICAL SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MELINDA
Authorized Official - Last Name:CHAIT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:401-615-5384
Mailing Address - Street 1:57 KNOTTY OAK SHRS
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-7940
Mailing Address - Country:US
Mailing Address - Phone:401-615-5384
Mailing Address - Fax:
Practice Address - Street 1:1020 PARK AVE
Practice Address - Street 2:SUITE 213
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-3227
Practice Address - Country:US
Practice Address - Phone:401-808-0070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00945103T00000X, 103TB0200X, 103TC2200X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty