Provider Demographics
NPI:1295014967
Name:WHITE, BRYANA FC (MA PYSCH)
Entity type:Individual
Prefix:
First Name:BRYANA
Middle Name:FC
Last Name:WHITE
Suffix:
Gender:F
Credentials:MA PYSCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ROBERTS CT
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02881-1792
Mailing Address - Country:US
Mailing Address - Phone:508-472-6391
Mailing Address - Fax:
Practice Address - Street 1:1130 TEN ROD RD STE E305
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4176
Practice Address - Country:US
Practice Address - Phone:401-294-0451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
RIPS02149103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health